Radioactive implant planning system and placement guide system

ABSTRACT

An implant planning system aids delivery of radiation to tumor sites of a patient. The system allows a user to test various combinations of virtual implants, each associated with a corresponding physical implant (e.g., a carrier with an embedded radioactive seed), and to view the dosage area of the virtual implants so that adjustments to the virtual implants may be made until a prescribed dose of radiation to a treatment area is achieved. A treatment plan developed based on the virtual implants may then be used in surgical implantation of the corresponding physical implants. For example, the implant configuration of the treatment plan may be projected onto a treatment surface of a patient, such as in a surgical room, so that physical implants may be placed according to the projected image of the virtual implants.

BACKGROUND

Implants have been developed that emit radiation or chemicals and can beplaced within or on a patient's body, for example for the purpose oftreating disease or improving health. For example, implants may containradioactive material to treat adjacent cancer. In another example,implants may emit chemical agents that could for example, treat disease,or promote tissue healing.

SUMMARY

There is a need for systems and methods that make the planning ofimplant type, number, strength, location, and/or configurationefficient, intuitive, and accurate. In addition, once a plan forimplants has been created, there is a need for ways of guiding the user,for example the surgeon, in accurately and efficiently placing thephysical implants in or on the body.

Multiple features will be discussed herein that address these needs.First, in one embodiment an implant planning system provides novel userinterfaces to allow the user to create a plan for implants in a way thatis efficient, intuitive, and accurate. Second, an implant placementguide system makes it simple, intuitive, and accurate for the surgeon toplace physical implants based on the implant plan. In some embodimentsthe implant placement guide system may even control medical equipment,such as robotic surgical equipment, to place implants into a patient,such as with limited or no input from the surgeon.

Various features of these improvements are discussed below, and may beused together in various combinations or independently. For example, theimplant placement guide system (also referred to herein as the “implantplacement system” or simply “the system”) could be used to aid a surgeonin placing physical implants based on an implant plan developed withsoftware systems other than those disclosed herein with reference to theimplant planning system. Similarly, an implant plan developed by thesystem may be implemented using other implantation systems.

While the examples shown use radioactive implants placed on the brainfor the purposes of treating cancer, the systems and methods describedherein may be used in many other applications.

In the examples shown, a photographic image of the brain is used for thepurposes of planning implant placement. However, the planning image maybe any two-dimensional (2D) image or three-dimensional (3D) surface, forexample created using 3D surface rendering of information acquired usingMagnetic resonance imaging (MRI), computed tomography (CT), ultrasound,or optical imaging.

In one embodiment, a computing system for developing a treatment planfor placement of radioactive implants on a treatment surface of apatient comprises a computer processor and a computer readable storagemedium storing program instructions configured for execution by thecomputer processor. In one embodiment, the program instructions causethe computing system to generate a planning user interface including atleast a display frame for viewing anatomical images, and a virtualimplant toolbar including at least a first selectable tool configured toallow adding of virtual implants to the display frame, and to displaythe planning user interface on a display device of the computing system.In some embodiments, the instructions further cause the computing systemto receive, from a user of the computing system, identification of afirst medical image as a planning image, the first medical imagedepicting a treatment surface of a patient, display the planning imagein the display frame of the planning user interface, receive, from theuser of the computing system, selection of first virtual implantcharacteristics for a first virtual implant to be added to a treatmentplan for the patient, the first virtual implant characteristicsincluding at least a first virtual implant shape, a first virtualimplant size, and a first radiation characteristic of a first seedassociated with the first virtual implant. In some embodiments, theinstructions further cause the computing system to receive, from theuser of the computing system, selection of second virtual implantcharacteristics for a second virtual implant to be added to a treatmentplan for the patient, the second virtual implant characteristicsincluding at least a second virtual implant shape, a second virtualimplant size, and a second radiation characteristic of a second seedassociated with the second virtual implant. In some embodiments, theinstructions further cause the computing system to display the firstvirtual implant and the second virtual implant in the display frame,wherein the first and second virtual implants are at least partiallytransparent such that a portion of the planning image whereupon thefirst and second virtual implants are placed is visible through the atleast partially transparent first and second virtual implants. In someembodiments, the instructions further cause the computing system toreceive, from the user of the computing system, selection of a secondselectable tool of the virtual implant toolbar configured to initiatemovement of a selected one or more virtual implants within the displayframe, receive movement inputs associated with the first virtual implantcausing the first virtual implant to contact the second virtual implant,and apply a physics algorithm, and based on the movement of the firstvirtual implant into the second virtual implant, to determine a movementof the second virtual implant in response to a virtual force exerted bythe first virtual implant. In some embodiments, the instructions furthercause the computing system to calculate a radiation isodose planindicative of an expected radiation dosage from combination of firstradiation from the first virtual implant and second radiation from thesecond virtual implant, wherein the radiation isodose plan includes aplurality of isodose curves each indicative of a particular radiationlevel along the respective isodose curve and a plurality of fillpatterns between adjacent isodose curves, wherein each fill patternrepresents a radiation range between adjacent isodose curves and depictthe radiation isodose plan in the display frame, wherein the radiationisodose plan has a transparency of less than one hundred percent, suchthat at least a portion of the first and second virtual implants and theplanning image underneath the radiation isodose plan are visible. Insome embodiments, the instructions further cause the computing systemto, in response to a treatment plan generation command from the user ofthe computing system, generate treatment plan data usable to procure afirst physical implant associated with the first virtual implant and asecond physical implant associated with the second virtual implant, thetreatment plan data including at least some of the first virtual implantcharacteristics and at least some of the second virtual implantcharacteristics.

In some embodiments, the instructions further cause the computing systemto transmit the treatment plan data to an implant provider with arequested delivery date and location for delivery of physical implantsassociated with each of the virtual implants indicated in the treatmentplan.

In some embodiments, the treatment plan data is automaticallytransmitted via an electronic communication to the implant provider.

In some embodiments, the program instructions are further configured tocause the computing system to receive, from the user of the computingsystem, selection of a second selectable tool of the virtual implanttoolbar configured to initiate movement of a selected one or morevirtual implants within the display frame, wherein the virtual carriersare configured to interact with one another in a manner similar tointeractions between corresponding physical implants.

In some embodiments, the program instructions are further configured tocause the computing system to receive, from the user of the computingsystem, a request to update the planning image to a second medical imageof the patient, wherein the medical image of the patient and the secondmedical image of the patient depict a common plane of the patient'sanatomy.

In some embodiments, the program instructions are further configured tocause the computing system to receive, from the user of the computingsystem, a request to replace the planning image with a live video feedof the treatment surface.

In some embodiments, the program instructions are further configured tocause the computing system to execute a registration process to alignanatomical features of the second medical image with those of themedical image such that each particular anatomical feature in the secondmedical image will be rendered at a same location in the display frameas the particular anatomical feature is rendered in the medical imagedisplayed in the display frame.

In some embodiments, the program instructions are further configured tocause the computing system to replace the medical image with the secondmedical image in the display frame, while maintaining display of thefirst virtual implant, the second virtual implant, and the radiationisodose graph.

In some embodiments, the planning user interface further includes anisodose level user interface control selectable by the user to adjust aplane parallel to the treatment surface in the planning image at whichthe isodose curves are calculated, wherein adjustment of the planeinitiates real-time updating and display of the radiation isodose planat the updated plane.

In some embodiments, the planning user interface further includes anisodose transparency user interface control selectable by the user toadjust transparency of the radiation isodose plan.

In some embodiments, the isodose transparency user control includes afirst transparency button that, when selected, adjusts transparency ofthe radiation isodose plan to fifty percent and a second transparencybutton that, when selected, adjusts transparency of the radiationisodose plan to seventy-five percent.

In some embodiments, the virtual implant toolbar further includes a seedstrength user interface control selectable by the user to adjust seedstrength of a selected virtual implant.

In some embodiments, seed strengths that are available for selection inthe seed strength user interface control are limited to seed strengthsthat are available for use at a determine implantation time.

In some embodiments, the first virtual implant characteristics indicatea position of the first seed between a top and bottom surface of thefirst virtual implant, wherein the position has a default at a locationwherein the first seed is closer to the top surface such that moreradiation is emitted from a top surface of a corresponding physicalimplant than a bottom surface of the corresponding physical implant,wherein the virtual implant toolbar further includes a flip control. Insome embodiments, in response to the user selecting the flip control andselecting the first virtual implant the position of the first seedbetween the top and bottom surfaces of the first virtual implant isupdated so that the position of the first seed is closer to the bottomsurface such that more radiation is emitted from the bottom surface ofthe corresponding physical implant than the top surface of thecorresponding physical implant, and the radiation isodose plan isupdated to reflect any changes to the calculated dosage at the isodoselevel.

In some embodiments, the virtual implant toolbar further includes acomposite implant control configured to create an association betweenthe first virtual implant and the second virtual implant, wherein inresponse to the user selecting the composite implant control apositional relation between the first virtual implant and the secondvirtual implant is determined and a composite implant comprising thefirst and second virtual implant in the determined positionalrelationship is defined, wherein the composite implant is moveable bymovement of either of the first or second virtual implant.

In some embodiments, the virtual implant toolbar further includes acomposite implant control configured to create a composite implantincluding two or more virtual implants each having common implantcharacteristics, wherein the composite implant is displayed in thedisplay frame and is moveable in response to movement of any of the twoor more virtual implants.

In some embodiments, the virtual implant toolbar further includes a flipcontrol and, in response to the user selecting the flip control andselecting the first virtual implant of the composite implant, the firstvirtual implant is disassociated from the composite implant such that aposition of a first seed in the first virtual implant is updated, but aposition of the second seed in the second virtual implant is notupdated.

In another embodiment, a computing system comprises a computerprocessor, and a computer readable storage medium storing programinstructions configured for execution by the computer processor. In someembodiments, the computing system generates a planning user interfaceincluding at least a display frame for viewing anatomical images, and avirtual implant toolbar including at least a first selectable toolconfigured to allow adding of virtual implants to the display frame, anddisplays the planning user interface on a display device of thecomputing system. In some embodiments, the instructions further causethe computing system to receive, from a user of the computing system,identification of a first medical image as a planning image, the firstmedical image depicting a treatment surface of a patient, and displaythe planning image in the display frame of the planning user interface.In some embodiments, the instructions further cause the computing systemto receive, from the user of the computing system, selection of firstvirtual implant characteristics for a first virtual implant to be addedto a treatment plan for the patient, the first virtual implantcharacteristics including at least a first virtual implant shape, afirst virtual implant size, and a first radiation characteristic of afirst seed associated with the first virtual implant, receive, from theuser of the computing system, selection of second virtual implantcharacteristics for a second virtual implant to be added to a treatmentplan for the patient, the second virtual implant characteristicsincluding at least a second virtual implant shape, a second virtualimplant size, and a second radiation characteristic of a second seedassociated with the second virtual implant, and display the firstvirtual implant and the second virtual implant in the display frame. Insome embodiments, the instructions further cause the computing system todetermine a radiation range prescribed for treatment of the patient,receive, from the user of the computing system, drawing inputsindicating a treatment area of the planning image, and depict at leastan outline of the treatment area on the treatment image. In someembodiments, the instructions further cause the computing system tocalculate for each of a plurality of subregions within the treatmentarea an expected radiation level based on first radiation from the firstvirtual implant and second radiation from the second virtual implant,and depict on the treatment area one or more of: a first color or visualindication of any subregions having expected radiation levels below theprescribed radiation range, a second color or visual indication of anysubregions having expected radiation levels above the prescribedradiation range, or a third color or visual indication of any subregionshaving expected radiation levels within the prescribed radiation range,wherein all subregions of the treatment area are associated with one ofthe first, second, or third color or visual indication.

In some embodiments, the first color or visual indication is a yellowcolor, the second color or visual indication is a red color, and thethird color or visual indication is a green color.

In some embodiments, the drawing inputs are provided via movement of afinger or stylus on a touch-sensitive display or input device, ormovement of a mouse, to draw the treatment area.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 Illustrates an example system that may be used to implement theinventions described herein.

FIG. 2 is a flowchart illustrating one embodiment of a method ofplanning placement of implants and guiding placement of the implants.

FIG. 3 shows an example of an imaging device 310 acquiring a digitalimage of the anatomy that will be used as a planning image.

FIG. 4A illustrates an example of a graphical user interface 400 thatmay be generated by the implant planning system, such as may beimplemented on the computing device 150.

FIGS. 4B-4D show various stages of development a treatment plan usingthe planning system software and planning software user interface.

FIG. 4E is similar to FIG. 4D, but the user has pressed the “75%” buttonto cause the system to display the isodose plan and virtual implantswith 75% opacity.

FIG. 4F is similar to FIG. 4E but the user has pressed the “Isodose”button, to cause display of the isodose plan without transparency andwithout display of the virtual implants.

FIGS. 5A-5C illustrates additional interface elements that may beincluded in certain user interfaces generated by the implant planningsystem.

FIG. 5D illustrates an example of the Add and Move operations.

FIG. 5E illustrates another example of how virtual implants act likephysical objects with respect to collisions.

FIG. 5F illustrates another example button bar that includes a compositetile button.

FIG. 5G illustrates placement of a composite tile and movement of thecomposite tile.

FIG. 5H illustrates a process of disconnecting a virtual implant from acomposite tile by flipping the virtual implant.

FIG. 6A illustrates a number of virtual implants that the user hasplaced on the planning image, illustrated as multiple square,rectangular, and circular graphics, representing various types andconfigurations of virtual implants.

FIG. 6B illustrates measurement of dose at different positions.

FIG. 7A illustrates a planning image manipulated so that it is a roughlyblack and white image, for example by removing color and increasingcontrast, and then made semitransparent.

FIG. 7B illustrates the processed planning image superimposed on theanatomy and one can appreciate that the images are not perfectlyaligned, as evidenced by the apparent double copy of the vesselindicated by the white arrow.

FIG. 8 illustrates an embodiment where a digital projector 160 projectsthe plan, in this example as the black and white virtual implants, on tothe patient's body 820, in this example a patient's brain duringsurgery.

FIG. 9 illustrates an example of virtual implants being simultaneouslydisplayed with the patient's anatomy to guide the surgeon in placingphysical implants at the time of surgery.

FIG. 10 shows an example of a live video image depicting the anatomy,including a surgical instrument, for example obtained with camera 310 ofFIG. 3 or Camera 158 of FIG. 1.

FIG. 11 illustrates a surgical instrument using a gray computer graphic,for example representing an instrument controlled by a surgical robot.

FIG. 12 illustrates an example of a graphical user interface that may begenerated by the implant planning system, such as may be implemented onthe computing device 150.

FIGS. 13A and 13B illustrates an example graphical user interface inwhich various images may be displayed.

FIG. 14 illustrates display of isodose curves representing radiationdose where the scale of values displayed may be varied.

FIG. 15 illustrates display of isodose curves at various depth planesrelative to the radiation sources.

FIG. 16 illustrates a function where the user may interactively draw alesion or region to be treated.

FIGS. 17A and 17B illustrate a graphical user interface where drawnlesions or regions to be treated may be interactively displayed orhidden.

FIGS. 18A, 18B, 18C, and 18D illustrate functionality where lesions orregions to be treated may be drawn on one or more images and displayedon all images.

FIG. 19 illustrates a system where a desired range of radiation dose maybe selected by the users and various portions of a drawn lesion orregion to be treated may be automatically color-coded to illustrateregions that fall below, within, and above the desired dose range.

FIG. 20 illustrates interactive adjustment of the prescribed dose rangewith automatic analysis and color coding of the region to be treated toshow which components fall below, within, and above the treatment range.

FIG. 21 illustrates display of the treatment region and varioussuperimposition of an isodose plan.

FIG. 22 illustrates a region to be treated with several different seedconfigurations and the resulting display of the treatment region.

DETAILED DESCRIPTION Definitions

In order to facilitate an understanding of the systems and methodsdiscussed herein, a number of terms are defined below. The terms definedbelow, as well as other terms used herein, should be construed toinclude the provided definitions, the ordinary and customary meaning ofthe terms, and/or any other implied meaning for the respective terms.Thus, the definitions below do not limit the meaning of these terms, butonly provide exemplary definitions.

Implant planning system (also referred to herein as a “planningsystem”): One or more computing systems that executes planning softwarein order to generate a planning system user interface in which a usercan efficiently, intuitively, and accurately create a treatment plan bymanipulating virtual implants as if they are physical objects. Forexample, virtual implants may be manipulated to change an expectedoutput/consequence of associated physical implants, such as radiationdose levels, drug concentrations, etc., in order to achieve a desiredprescribed dosage.

Implant placement guide system (else referred to herein as a “guidesystem” or an “implant guide system): One or more computing systems thataids a user and/or other system (e.g., a robotic surgical instrument) inimplementing a treatment plan developed by the implant planning system(or other planning system), such as by executing implant guidancesoftware. In some embodiments, the implant guidance software displays(e.g., on a display device in an operating room) the locations, types,strengths, and/or configuration of virtual implants simultaneously withimaging of the anatomy at the time of implantation to guide the surgeon,or other user, in placing the implants. In some embodiments, the implantguidance software is in communication with a projection device (e.g., ahigh definition video projector in an operating room) and transmitsportions of the treatment plan (e.g., the locations, types, strengths,and/or configurations of virtual implants) for projection onto atreatment surface of the patient.

In some embodiments, an “implant planning system” includes both theimplant planning software and the implant guidance software. Thus,references to an implant planning system herein may refer to a systemthat provides one or both of the implant planning software and/or theimplant guidance software.

Tumor: an abnormal growth of tissue resulting from uncontrolled,progressive multiplication of cells. Tumors can be benign or malignant.

Tumor bed: an anatomical area of a patient (e.g., a human or othermammal) where a tumor exists (pre-operative tumor bed) and/or an areasurrounding a surgically removed tumor (post-operative tumor bed), suchas a cranial cavity from which a tumor was surgically removed. Evenafter surgical removal of a tumor, the remaining tumor bed of thepatient may include tumor cells.

Treatment area: an anatomical area that is targeted for delivery ofradiation, such as from one or more radiation delivery devices (e.g.,the implants discussed below). A treatment area may include tissue belowand/or around a location where the radiation delivery devices arepositioned, such as an anatomical area of a tumor, a tumor bed, or someother area where radiation treatment is desired.

Treatment surface: an anatomical surface of a patient where a radiation(or other treatment) delivery device is to be placed to deliverradiation to a treatment area, such as the treatment surface itselfand/or tissue below and/or around the treatment surface. A treatmentsurface may be a portion of a tumor bed or any other anatomical surface.For example, if a tumor bed is surgically created, such as a cranialcavity that is created after removal of a brain tumor, the treatmentsurface may include some or all of an exposed surface of thepost-operative tumor bed and/or some portion of tissue surrounding thecavity.

Brachytherapy: radiation treatment in which the radiation deliverydevice is placed directly on and/or close to a treatment surface of thebody, such as directly on the surface of the body, within the body, orin a tumor bed. For example, brachytherapy may be intracavitary, such asin cranial or gynecologic malignancies; intraluminal, such as inesophageal or lung cancers; external, such as in cancers of the skin;and/or interstitial, such as in treatment of various central nervoussystem tumors as well as extracranial tumors of the head, neck, lung,soft tissue, gynecologic sites, rectum, liver, prostate, and penis. Inthe embodiments discussed herein, the implants are placed on thetreatment surface, rather than being embedded within tissue (such as bya syringe injecting a radioactive seed below an exposed surface of asurgical cavity). However, the treatment planning software may be usedin planning of placement of any type of implant, including the surfacemounted implants discussed herein as well as other types of implantssuch as shallow or deep tissue implants.

Seed: a radioactive material that is configured for delivery ofradiation to a treatment area. A seed may be in various shapes andsizes, such as cylinder, cone, sphere, pyramid, cube, prism, rectangularprism, triangular prism, and/or any combination of these or othershapes. While seeds are generally referred to herein as cylindrical, anyother shape or size of seed may alternatively be used in the varioussystems and methods discussed herein. Seeds may comprise any combinationof one or more of multiple radioactive components, such as Cs 131, Ir192, I 125, Pd 103, for example. Seeds may include a protective outershell that partially or fully encases the radioactive material.

Carrier: a substrate that holds or contains a radioactive seed. Acarrier that contains one or more seeds is a radiation delivery device.Carriers may be configured for permanent implantation into a tumor bed,such as to provide radioactive energy to a treatment surface surroundingan area where a tumor has been removed in order to treat any remainingmalignant tissue. Carriers can be composed of various materials and takeon various shapes and sizes. Examples carriers, such as carriers havingvarious sizes, shapes, configurations, etc., are included in thefollowing patent and patent application, each of which is herebyincorporated by reference in its entirety and for all purposes: U.S.patent application Ser. No. 13/460,792, titled “DosimetricallyCustomizable Brachytherapy Carriers And Methods Thereof In The TreatmentOf Tumors,” and U.S. patent application Ser. No. 14/216,723, titled“Dosimetrically Customizable Brachytherapy Carriers And Methods ThereofIn The Treatment Of Tumors.”

Implant (also referred to as a “physical implant”): A device that isplaced in or on the patient (e.g., human or animal) for the purpose oftreating the patient. Implants may emit various types of energy orchemical agents. For example, implants may contain radioactive materialthat emits radiation for the purpose of treating tumors. In anotherexample, implants may emit chemicals, such as chemotherapeutic agentsused to treat cancer or other agents used, for example, to promote softtissue or bone healing or regeneration. For ease of description,examples of the planning and placement system discussed herein areprimarily discussed with reference to implants comprising a carrier thatcontains one or more radioactive seeds. However, any other implants arecompatible with the systems and methods discussed herein.

Planning image: An image of the anatomy, such as a treatment surface,that is viewed by the user to plan therapy through the placement ofvirtual implants on the planning image. A planning image may be a singleimage or a set of images that describe the anatomy from various views orin 3D, for example a series of MRI or CT scans through the anatomy ofinterest.

Treatment plan (also referred to herein as a “plan”): Indications oftreatment to be provided to a patient, such as might be developed by theimplant planning system. As discussed in further detail below, aradiation treatment plan may be developed based on one or more planningimages and a technician (e.g., a radiologist, oncologist, dosimetrist,etc.) using the planning system to determine the appropriate locationsand characteristics of virtual implants (and/or the implant planningsystem automatically determining locations and characteristics ofimplants based on a provided dosage prescription, for example) based oninteractions with virtual implants. In some embodiments, a radiationoncologist may define a patient's critical organs and tumor (or othertreatment area) and a dosimetrist may provide target doses andimportance factors for each. With these planning inputs, the implantplanning system may execute and, in cooperation with inputs from theuser in some embodiments, develop a treatment plan which best matchesall the input criteria.

Virtual Implant: A user interface element representing a physicalimplant that can be placed by the user of the implant planning systeminto an implant planning user interface to see the expected dose totissue that will result from the corresponding physical implants. Usingthe implant planning system described herein, the user may add, modify,remove, and move virtual implants utilizing the planning system userinterface displayed on a computing device and in close to real time (orreal time) see the resulting dosage changes to the anatomy (e.g., thetreatment area and/or surrounding area depicting in the planning image),allowing the user to interactively plan the types, strengths,configuration, and/or locations of virtual implants in a simulationbefore generating a treatment plan for use in placing the actualphysical implants in a patient.

Calculated Dose: An amount of radiation or chemicals that will reach thetissues as a result of the placement of physical implants. For example,in the case of radiation implants, the (calculated) dose to tissue maybe calculated using equations that account for the strength of eachimplant, its distance from the position for which the dose iscalculated, and the intervening tissues, where the dose calculation mayaccount for distance, radiation scatter, radiation absorption, and/orany other relevant factor. In the case of implants that release chemicalagents, the calculated dose in different locations may be calculatedbased on factors such as the rate of release of the agent from theimplant, tissue metabolism, solubility, diffusion, tissue perfusion,and/or any other relevant factor.

Isodose curve (also referred to herein as an “isodose line”): agraphical indication, such as a line, indicating points of equal doseabout a radiation source, such as a radioactive seed. Multiple isodosecurves may be drawn around a radiation source at regular intervals ofabsorbed dose, or other intervals. In some implementations, isodosecurves indicate percentages of a dose that are absorbed along theisodose curve.

Isodose plan (also referred to herein as an “isodose plot” or “isodoseplan”): A graphical representation of the calculated dose(s) across anarea of tissues. An isodose plan may include a group of isodose curveseach associated with a different calculated dose. An isodose plan mayinclude various patterns and/or fills between adjacent isodose curves,such as varying colors, shading, patterns, and/or other visualindicators that represent corresponding dose ranges between adjacentisodose curves. In certain examples shown in the figures, varyingdensities of dot patterns are used between isodose curves to representdose ranges between the respective isodose curves. In someimplementations, dosage ranges may be represented by different colors toprovide a more distinct separation between isodose curves. For example,certain of the figures generally use varying pattern densities as showbelow that may correspond to the indicated colors in certainimplementations of the planning software:

-   -   red (dense dot pattern) highest dosage range    -   orange    -   yellow    -   green    -   light blue (moderately dense dot pattern): median dosage range    -   light-intermediate blue    -   intermediate blue    -   dark blue    -   transparent or no color (least dense dot pattern): lowest dosage        range Depending on the embodiment, other color values or visual        indications may be used as an alternative to this color scheme        in order to indicate a calculated dose or dose range.        Overview of Certain Features

In certain examples shown, the user may use the planning system to planthe number, type, and/or location of various implants in order toachieve a desired clinical result. For example, in the example of tumortreatment, the user may desire to place implants in locations thatprovide radiation to regions that contain or contained tumor, whileminimizing radiation to normal tissues.

In certain examples shown, a graphical representation of the amount ofradiation that will be delivered to the tissues (dosimetry) by theradioactive implant(s) is shown as an isodose plan, where various colorsindicate various ranges of radiation delivered to the correspondingtissue. In other embodiments, similar or different graphical plots couldbe utilized to display, for example, various amounts of a drug thatwould be delivered to tissues as a result of emission of the drug fromthe implants.

Advantageously, the planning system allows the user to easily andintuitively add virtual implants of various types to positions in theplanning image and instantly (or almost instantly) see the estimatedamount of radiation that would be delivered to the corresponding tissuesif that treatment plan was implemented. In addition, the user may easilymove the virtual implants, for example by dragging them with a mousecursor or with a finger on a touch screen and almost instantly see thenew isodose curves that result from the new treatment plan.

In addition, the implant planning system may allow the user to selectfrom a variety of different implant types (e.g., virtual implant typeseach having a corresponding physical implant type) to add to a plan,including implants that do not contain radioactive seeds, and thereforeserve as physical spacers in a plan. For example, various shapes andsizes of virtual implants (e.g., so long as corresponding physicalimplants may be created) may be used in a treatment plan. In someembodiments, virtual implants may be moved as physics objects, such thatthe virtual implant simulate real world physical interactions. Forexample, a virtual implant that is moved towards and into a series ofvirtual implants may push the virtual implants apart in a similar manneras moving a domino on a tabletop would displace a series of otherdominos on the tabletop. The physical attributes of implants may bemodified in various implementations and/or may be modified by a user fora particular treatment plan or even for particular implants (e.g., avirtual implant placed on a center of a tumor bed may be “glued” to thatposition so that it does not move based on simulated physical forces ofadjacent implants, but the other implants may exhibit simulated realworld physical interactions.

In addition, the implant planning system may allow the user to deletevirtual implants or change the configuration of virtual implants, forexample by flipping them in the case of virtual implants where theradioactive seed within a virtual implant is asymmetrically positionedwith respect to the virtual implant surfaces. In this way, the user mayrapidly and intuitively create a treatment plan including the number,type, and/or location of actual physical implants using virtual implantsthat may be adjusted and manipulated in the various manners discussedherein to achieve the desired treatment goals.

Example System Architecture

FIG. 1 illustrates one example of an implant planning system 150, whichmay also be referred to herein as simply the “computing device 150” or“the device 150.” In this embodiment, the computing device 150 includessoftware modules 151, one or more processors 152, memory and storage153, an operating system 154, a display 155, input devices 156, such asa mouse keyboard or touchscreen, interfaces 157, and optional camera158.

A number of different technologies could be utilized to obtain planningimages, for example MRI scanner 124, CT scanner 126, or a 2-D or 3-Dimaging device 128, for example using 2D or 3D optical or ultrasonicimaging. In some embodiments, 3D information, for example acquired usingMRI, CT, ultrasound, or optical imaging may be processed to form a 2D or3D surface for planning, for example utilizing 3D processor 122 andtechniques such as surface rendering, volume rendering, or multiplanarreconstruction (MPR).

PACS system 120 may be used to manage, store, and transmit images andother medical information, including information used by and produced bysystems and methods described herein, including the planning image andthe treatment plan, which may include implant types, configurations, andlocations as well as dosimetry or other calculations.

Optional planning server 140 may serve a variety of optional functionsin various embodiments. For example, the planning server 140 may storeprior dosimetry or other treatment information that a patient hasreceived which may be made available to the user of the system, as priortherapy in various spatial locations may influence the planning ofadditional therapy to be delivered by implants. In some embodiments, theplanning server 140 may perform dose calculations, rather thanperforming the calculations on computing device 150. The planning servermay store information regarding various types, configurations, andstrengths of implants available for use, which may be represented asvirtual implants in the planning system UI during the treatment planningprocess.

In some embodiments, the planning system described herein may transmit atreatment plan, or a portion of a treatment plan, to an ordering system142 so that the physical implants included in the treatment plan can becreated and shipped to the user in advance of the operation in whichthey are to be implanted. For example, some radioactive implants emitradiation over a relatively short period of time and need to be orderedfrom a supplier in advance of the surgery where they are to beimplanted. Using systems and methods described herein, a user may createa plan in advance of surgery, for example using a planning imageobtained preoperatively, for example using MRI, and the number and typeof implants used in the plan may be transmitted to Ordering System 142,instructing the company that produces the implants to deliver the neededimplants to the user in advance of surgery.

For example, in one embodiment the planning system may generate an email(or other data package, such as a comma separate values (CSV) file ortext file) including physical implant information (based on the finalvirtual implants of a treatment plan) and automatically (or after userreview in some embodiments) transmit the information via email to anordering system. As an example, the data package (e.g., body of an emailto the ordering system) may include information in a format such asbelow, which indicates the physical implant shape (e.g., “TILE”),strength (e.g., maximum radiation emitted from the radioactive seed),and the planned anatomical position of the physical tile at thetreatment area (e.g., in x, y, z coordinate with reference to anabsolute position, such as a lower left corner of the planning image):

-   -   9 sources    -   [1] TILE strength=3.7 at (6.443, 5.100, 0.300)    -   [2] TILE strength=3.7 at (4.823, 7.242, 0.300)    -   [3] TILE strength=3.7 at (6.286, 7.300, 0.300)    -   [4] TILE strength=3.7 at (7.486, 6.314, 0.300)    -   [5] TILE strength=3.7 at (5.529, 5.971, 0.300)    -   [6] TILE strength=3.7 at (3.943, 5.329, 0.300)    -   [7] TILE strength=3.7 at (3.514, 6.414, 0.300)    -   [8] TILE strength=3.7 at (3.992, 7.858, 0.300)    -   [9] TILE strength=3.7 at (7.614, 7.971, 0.300)        The data package may also include an image of the treatment        plan, such as a screen shot or image export of the display frame        410 (or the entire user interface 400). As noted elsewhere, the        data package sent to an ordering system may include various        other information in various formats and the information may be        transmitted using methods other than email, for example via a        secure web service.

As described further below with reference to the implant placement guidesystem, that system may guide the user, for example the surgeon, inplacing physical implants in or on the patient's body, based on adeveloped treatment plan. In one embodiment described below, informationfrom the plan may be projected on to the patient's body, for exampleusing Projection System 160.

In some embodiments, a real time image of the anatomy (e.g., thetreatment surface of the patient) may be acquired, for example, usingCamera 158 and/or 2D or 3D imager 128, and the treatment plan (e.g.,locations, types and/or configurations of the virtual implants) aregraphically superimposed on this real time image to guide the surgeon inplacing actual implants in the locations of the virtual implants in theplan.

Example Planning and Placement System(s)

In one embodiment, development of a treatment plan using virtualimplants and guiding of surgical implant placement based on thetreatment plan may be performed by the computing device 150. In otherembodiments, separate computing devices, such as an implant planningsystem and an implant placement guide system, respectively, control theprocesses of developing treatment plans (e.g., a radiation oncologist orother doctor at a remote location to a hospital may perform theplanning) and guiding the surgeon in placing the implants according tothe plan. Additionally, as noted above, in some embodiments the implantplanning process may be performed entirely independent of the actualsurgical implant process, such that other surgical implant guide methodsmay be used in order to implement a treatment plan developed using theimplant planning system discussed herein. Similarly, an implanttreatment plan developed using other methods (e.g., manually or usingother software applications) may be used by the implant placement guidesystem in order to guide a surgeon in implementing the developed plan.The implant planning system, implant placement guide system, and/orother systems and computing devices discussed herein may each includesome or all of the same or similar components discussed with referenceto device 150 of FIG. 1. Depending on the embodiment, the method of FIG.2 may include fewer or additional blocks and/or the blocks may beperformed in an order different than is illustrated.

Beginning at block 205, a planning image (or images) is acquired. FIG. 3illustrates a conceptual diagram of an imaging system 310 (e.g., any ofthose devices discussed herein that may obtain a planning image)acquiring a planning image of anatomy 320. The planning image may be atwo dimensional image, for example obtained with a digital camera, ormay be a 3D image or 3D surface, for example a 3D surface obtained usingdata acquired by various modalities such as magnetic resonance imaging,computed tomography, ultrasound, or 3D optical imaging. Examples ofstructures from which 3D planning images may be acquired includesurgical cavities, the internal surface of a bronchus or portion of thegastrointestinal tract, the brain, the skin, and perineum.

Planning images may be obtained preoperatively, for example usingtechniques such as magnetic resonance imaging (MRI), computed tomography(CT), photography or endoscopy, or planning images may be obtained atthe time of surgery, for example using digital photography, 3D opticalimaging, ultrasonography, or intraoperative MRI or CT.

Moving to block 210, a treatment plan is created utilizing the implantplanning system and virtual implants, as will be described in moredetail below, such as with reference to FIGS. 4A-6A.

In block 215, physical implants may be optionally ordered based on thetreatment plan created in block 210. This may be done in an automatedfashion, for example via transmission of the configuration, number,type, and strengths of the implants within the treatment plan. In somecases, physical implants or implant components may have long lives and astock of implants may be available to the user. In other cases, physicalimplants or implant components (e.g., the carrier material, such ascollagen, and/or the radioactive component, such as a seed) may haveshort lives, and need to be ordered in a short timeframe prior toimplementation. In particular, a physical implant with a long life maycomprise components having a useable time period of greater than 3months (or some other time, such as 1 month, 6 months, a year, etc.).For example, an expiration date, or date by which it is best to use amanufactured physical implant, may indicate a useful life of thephysical implant. Physical implants with short lives may have expirationdates, best used by dates, or shelf life periods, that encourage use ofsuch physical implants within a shorter timeframe from manufacturing ofthe physical implant, such as in less than 1 week (or some other time,such as 1 day, 3 days, 2 weeks, 1 month, etc.).

In some embodiments, the physical implants may be ordered based on anestimate of what the treatment plan will consist of, and then a plan maybe created after the implants have arrived. In one embodiment, where theplan is developed immediately prior to implantation, the planningsoftware may display to the user an inventory of available physicalimplants that are available for use in the plan (e.g., inventory that ison-site or available in a necessary time frame in order to complete thesurgery).

In block 220, the plan is implemented using the implant placement guidesystem, such as by displaying the locations, types, strengths, and/orconfiguration of physical implants simultaneously with imaging of theanatomy at the time of implantation to guide the surgeon, or other user,in placing the implants, as will be describe below.

In block 225, the surgeon, other user, and/or an automated (e.g.,robotic) placement system, places the physical implants according to theplan and using guidance from the implant placement guide system.

Example Planning System Operations

FIG. 4A illustrates an example planning system user interface 400 thatmay be generated by an implant planning system in some embodiments. Theuser interface 400 may be partially or entirely generated on a serverdevice, for example, and viewable on a user device such as via a thinclient connection, in some embodiments. In other embodiments, the userinterface 400 may be partially or entirely generated on the usercomputing device, such as a radiologist, oncologist, surgeon, and/orother computing devices. In some embodiments, the user interface 400includes sharing functionality that allows multiple users toconcurrently create a treatment plan, such as by allowing an oncologistand surgeon to concurrently view the user interface, and a dynamicallyupdated treatment plan including virtual implants, in order tointeractively develop an appropriate treatment plan for a patient. Thus,the computer device(s) that generate, process, and/or update informationreceived from one or more users in the planning system user interfacemay vary from one implementation to another, and all such variations arewithin the scope of this specification. For ease of illustration, theplanning software is primarily discussed herein as being generated by animplant planning system.

Certain interactions and operations performed with reference to planningsoftware are described below with regard to inputs provided via a touchscreen, where the user may touch a finger (or fingers, stylus, or otherphysical implement) to a position on the touch screen to provide input.In other embodiments, the user inputs may be received from any othersuitable input device, such as a cursor/mouse, keyboard, a 3D inputsystem such as a Leap motion controller, or voice control, for example.

In the example of FIG. 4A, the user interface 400 includes a displayframe 410 which displays an example planning image, such as an imageacquired using the imaging device 310 of FIG. 3, on which the user mayplace virtual implants.

FIGS. 4B-4D illustrate respective bars of buttons 420, 430, and 440. Inthis implementation, each of the bars of buttons includes multiplebuttons configured such that the buttons within a particular bar act asradio buttons where only a single button may be selected at a time andselection of a button automatically deselects other buttons in the samebar of buttons. In other embodiments, other types or arrangement ofbuttons may be used to accomplish the various functions described below.Similarly, other user interface controls may be used in otherembodiments, such as sliders, check boxes, pull down menus, etc.

FIG. 4B displays button bar 420 from user interface 400 that may be usedto select various ways that information may be displayed in displayframe 410. In this example, options for display include the following:

-   -   Tiles: Display the virtual implants placed by the user        superimposed on or otherwise simultaneously with the planning        image, for example as illustrated in FIG. 4C. In one embodiment,        with the virtual tiles depicted in the display frame, subsequent        selection of the Tiles button removes the virtual tiles from the        display frame, such that display of the tiles may be toggled        with this button. In the example of FIG. 4C, the user has        selected the “Tiles” button to simultaneously display the        planning image and virtual implants (the plan). In this example,        the virtual implants are displayed as opaque so that the        underlying planning image may be simultaneously visualized. In        various embodiments, the virtual implants may be graphically        positioned on top of or beneath the planning images. One, both        or neither of the planning image and virtual implants may be        displayed as semitransparent in other embodiments and/or in        response to user input selecting an opacity level.    -   Video: Display the virtual implants placed by the user        superimposed on or otherwise simultaneously with a live image of        the anatomy (e.g., the treatment surface), for example as        described with reference to FIG. 10.    -   50%: Display the virtual implants and associated calculated        isodose plan with 50% transparency, superimposed on the planning        image, as in the example of FIG. 4D.    -   75%: Display the virtual implants and associated calculated        isodose plan with 75% opacity, superimposed on the planning        image, as in the example of FIG. 4E. In other embodiments, other        transparency levels may be included in a similar user interface        control. Similarly, in one embodiment the user may customize the        transparency levels that are available and/or select a custom        transparency level through a different user interface control,        such as a slider that incrementally adjusts the transparency. In        some embodiments, transparency of the virtual implants may be        selectable, rather than opacity. For example, an opacity of 25%        may be set in order to achieve a similar effect as setting        transparency to 75%.    -   Isodose: Displays the calculated isodose plan superimposed on        the planning image, as in the example of FIG. 4F. In this        embodiment, the isodose plan is displayed with no transparency        and without display of the Tiles. In other embodiments,        transparency level of the isodose plan and/or tiles may by        adjusted to any levels to depict various combination of those        display elements. The calculated isodose lines may be        automatically determined by the planning system, or selected by        a user, as predetermined values (e.g., an isodose line at each x        cGy from zero to a maximum calculated dosage (at any point in        the treatment plan) or to provide a particular quantity of y        isodose lines across a particular range, such as y isodose lines        at even intervals between zero and a maximum calculated dosage.        In other embodiments, values associated with isodose lines may        be determined in other manners, such as percentages relative to        a dose point maximum.

With reference to FIG. 4D, an isodose plan for the current combinationand placement of implants is displayed at a 50% transparency atop theplanning image. Thus, the isodose plan is displayed in a semitransparentmanner so the user may simultaneously visualize the isodose plan, thevirtual implants, and the underlying planning image. With reference toFIG. 4E, the user has pressed the “75%” button to cause the system todisplay the isodose plan and virtual implants with 75% opacity, and inthe example of FIG. 4F, the user has pressed the “Isodose” button tocause the isodose plan to be displayed at 0% transparency (or 100%opacity). In various embodiments, the isodose plan, implants, andplanning image may be shown with various degrees of transparency and invarious combinations, and the various graphics may be ordered indifferent ways.

Example Algorithms for Isodose Curve Calculations

In some embodiments, the dosimetry algorithm used to generate isodosecurves comprises calculating the radiation dose at each 3D position in aplane or curved surface that is z cm from the z position of the planningimage. In this embodiment, the dose at each point is the sum of the dosefrom each implant, where the radiation from each implant is proportionalto the strength of the radiation source for the implant divided by thedistance from the implant to the point squared, times an equation thataccounts for absorption of radiation and radiation scatter byintervening and adjacent tissue. The displayed graphic is in the form ofan isodose plan including multiple isodose curves, where fill patternsbetween adjacent isodose curves (which may be replaced by correspondingcolors or other graphical indicia in other embodiments) represents adifferent range of radiation delivered.

In another embodiment, implants could emit therapeutic agents and/or acatalyst that invokes or enhances therapeutic activity of anothertherapeutic agent or the tissue itself, other than radiation, such aschemotherapeutic agents, and other types of calculations could beutilized to show the user the expected delivery of the agent to thetissue. As with radiation implants, the user can use an interface systemsuch as this to decide on the type, configuration, strength, andlocations of chemical emitting implants to achieve the desiredtherapeutic effect, while minimizing the effect on adjacent normaltissue. Additionally, in some embodiments, the planning system may beconfigured to calculate an isodose plan for radiation treatment inconjunction with a therapeutic plan (that might look similar to theisodose plans discussed herein) indicating expected therapeutic level ofother agents delivered to a treatment area, such as by therapeuticvirtual implants, and display such plans in combination in order toallow planning of multiple modalities of treating a tumor site (or othersite).

In some embodiments, the implant planning system provides an inverseplanning component wherein the computer system automatically determinesa treatment plan comprising multiple virtual implants. Such a treatmentplan may be generated based on a provided prescribed dosage and atreatment area indicated on the planning image, such as by automaticallydetermining a combination of virtual implants that best delivers theprescribed dosage to the treatment area. The planning system mayautomatically generate the treatment plan based on one or more userselected parameters that impact which virtual carriers are selected toachieve the prescribed dosage. For example, the parameters may allow theuser to provide a desired balance between sparing of nearby tissue anddelivering the prescribed dosage in a uniform manner. Additionally, theplanning software and/or a user may indicate areas of tissue (either onthe treatment surface or below the treatment surface) to which radiationshould be avoided as much as possible (e.g. organs that are verysensitive to radiation) and/or other areas that are not as critical tospare radioactive damage. Thus, based on such factors, the implantplanning system could generate different configurations, such as sizes,orientations, positions, etc., of virtual implants for a particularprescribed dosage and treatment area to achieve different treatmentpriorities (e.g., as indicated in the parameters). In some embodiments,the implant planning system may initially provide a treatment plan usingthe inverse planning component, or may provide multiple treatment plansusing variations of treatment priorities/parameters for each developedtreatment plan, and allow the user to further manipulate the treatmentplan, if needed, using the systems and methods described below.

Virtual Implant Manipulation

FIG. 5A displays button bar 430 from user interface 400 (FIG. 4A) thatmay be used to select various operations that will occur when the userinteracts with a planning image displayed in display frame 410 and/or avirtual implant displayed in display frame 410.

-   -   Add: Adds a virtual implant of the currently selected implant        type, as described with reference to FIG. 5B, at the position        the user indicates on the planning image using, such as by        tapping a location on the planning image using a touch screen or        clicking a mouse with the cursor positioned on the planning        image.    -   Read: Displays an arrow or other indicator at the position the        user touches and displays the calculated dose at that 3D        location, with the z position (depth) of the location displayed        in the upper right region of the GUI. In some embodiments, the        calculated dose may be displayed as a relative dose (e.g., a        percentage of a maximum dosage calculated for any location        within the patient anatomy) and/or an absolute dose (e.g., the        absolute cGy at the selected 3D location).    -   Move: When this operation is active, the user may touch and drag        a virtual implant as if it were a real object. Virtual objects        act as physical objects in the user interface in that they        interact with each other so that a virtual object that collides        with others will push those other virtual objects.    -   Flip: Implant types may have a variety of states, e.g., default,        flipped, and empty (a spacer), as described with reference to        FIG. 5B. When Flip is selected, touching an implant causes it to        change to its next state and recycles to the default state once        the last available state is reached, e.g., a virtual implant may        cycle through default, flipped, spacer, and then back to default        when a virtual implant is touched or otherwise selected and the        “Flip” mode is active.    -   Delete: When this operation is active, touching a virtual        implant causes it to be deleted.

FIG. 5B illustrates button bar 440 showing types of implants availablein the example interface 400. Implants may have various configurations,and three configurations (tile, dot, and bar) are shown for each implantin a column below the respective tile, dot, and bar buttons on buttonbar 442, along with example graphic representations of each implant ineach of its configurations. In other embodiments more or fewer implantsmay be available, with various other configurations. In someembodiments, additional user interface controls may be available toallow further customization of virtual carriers that are included in thetreatment plan. For example, a control that customizes seed strength fora carrier may be included in some embodiments of the planning userinterface. In one embodiment, such a control may be implements as apop-up slider that appears when a seed shape (e.g., tile or dot) isselected, wherein the slider includes a selector that is movable betweena range of seed strengths that area available (and/or creatable). Thus,the user may customize each seed, if desired, using such controls,and/or may use a default seed strength by releasing the seed shapebutton (e.g., the tile or dot button) rather than sliding to aparticular seed strength after touching the button. In otherembodiments, any other characteristic of carriers may be selected in asimilar manner.

In the example shown, the default configuration of each implant containsa radioactive seed that is positioned 4 mm superior to its inferiorservice (not illustrated in this top view schematic). This is indicatedby the virtual implants in the first row of example graphicrepresentations in FIG. 5B, labeled as “default implant configuration.”A rectangle in the center of each virtual implant represents aradioactive seed within these virtual implants.

In the example shown, implants also have a “flipped” configuration, thesecond row example graphical representation in FIG. 5B, labeled as“flipped implant,” in which the radioactive seed is positioned 2 mmabove its inferior surface (in the particular example virtual implantdiscussed herein; other placements of seeds within carriers is expectedand are similarly usable in default and flipped formations). As thevirtual implants are placed on the virtual anatomic surface, thisconfiguration places the radioactive seeds closer to the anatomy, andtherefore they deliver a higher dose, as indicated by the largerrectangle graphic representing seeds in the virtual implants.

Implants may also have an “empty” configuration, as indicated in thethird row, where each implant has no internal seed. The virtual implantsmay act as spacers in this configuration, and indicate the position of aphysical spacer in a treatment plan.

Any other configuration, spacing, offset of seeds within implants, etc.,may be used in conjunction with implant planning system discussedherein. FIG. 5C illustrates additional interface elements that may beincluded in certain user interfaces generated by the implant planningsystem, such as the interface 400 of FIG. 4A. In this example, isodosedepth 452 indicates the z position, or depth relative to the treatmentsurface within the planning image, at which the dose is calculated forisodose curves and read function (for a particular three dimensionallocation within or outside of the patient anatomy). In the example ofFIG. 5C, the z position is −0.10 cm relative to the treatment surface,where a negative position indicates a position that is inferior to thetreatment surface.

In one embodiment, when the planning image is a plane, the dosecalculation is also a plane positioned at the indicated z position.However, when the planning image is a 3D image associated with a 3Dtreatment surface and/or 3d treatment area, the isodose depth indicatesa depth with reference to the actual treatment surface locations. Thus,the isodose depth relative to a top surface of a 3D volume, for example,may vary as the depth of the treatment surface varies.

In other embodiments, other geometries may be used to determine thelocations that a dose is calculated at a z distance from a 3D surface.For example, in another embodiment where the planning image is a 3Dsurface, each dose calculation (and the resulting isodose curves) may becalculated at a 3D point that is z cm from the treatment surface along avector that is normal (perpendicular) to the 3D surface at the point ofinterest. In another embodiment, dose calculations (and resultingisodose curve calculations) may be performed along flat planes, forexample where the orientation and position of the plane at z=0 is chosenby the user or automatically chosen by the system as a best fit to the3D curved surface.

In this example, button 454 allows the z position to be adjusted. Forexample, pressing the “+” may increase the z position by 0.1 cm andpressing the “−” may decrease the z position by 0.1 cm. In oneembodiment, the z position may be graphically represented in the displayframe, for example by varying the appearance of the displayed isodoseplan, for example by changing the depth of a shadow arising from theisodose curves or by varying the transparency of the isodose fills as afunction of z depth. In other embodiments, other types of user interfacecontrols may be used to change the z position, such as a slider bar.

In this example, an “eMail” button 456 may be used to transitinformation about the currently displayed treatment plan to othersystems or individuals. For example, in one embodiment the “eMail”button could have a different label, e.g., “Order”, and communicate theneeded implants to Ordering System 142, such as by transmitting part orall of the treatment plan to an implant provider.

In this example, a “Start Over” button 458 allows the user to clear thecurrent plan and start over, such as by removing all virtual implantsthat are currently part of the treatment plan.

FIG. 5D illustrates a portion of a planning image at three differentstages 490, 492, and 494 of a treatment planning process. Beginning atstage 490, the planning software is in Add mode, such as by the userselecting the Add button from button bar 430. While in Add mode, theuser has touched a position on the planning image and a virtual implanthas been placed (e.g., a square tile with a default seed positionoverlaid on an image of a patient's brain). Next, while remaining in Addmode, at stage 492 the user has touched a second position and a secondvirtual implant has been added, in this example shown with greatertransparency. In one embodiment, the user may vary the transparency ofindividual implants. In another embodiment, transparency may be used tographically represent a particular characteristic of implants, e.g.,implants with higher seed strengths could be displayed with reducedlevels of transparency. In another embodiment, different seed strengthswithin implants could be represented with another visual indicator, suchas alteration in color.

Next at stage 494, the user has selected Move mode, such as by selectingthe Move button from button bar 430 of FIG. 5A. While in Move mode, theuser has touched and dragged the second implant, and as it is draggedand collides with the first placed implant (at stage 490), that firstplaced implant is moved as the virtual implants act as if they werephysical objects. Thus, in this embodiment the virtual implants areassigned interaction properties to imitate how physical objects wouldinteract with one another in the real world, such as by pushing oneanother in response to impact of other implants. In other embodiments,the interactivity of implants may be adjusted, such as based on userpreference, so implants may actually be stacked on top of one another orplaced next to one another without pushing an adjacent implant.

FIG. 5E illustrates another portion of a planning image at two differentstages 496 and 498 of a treatment planning process. At stage 496, theuser has added a group of eight virtual implants, each with aradioactive seed, of various types. Above the group is a circularimplant that is empty, representing a dot spacer without a radioactiveseed.

At stage 498, the user has dragged the dot spacer inferiorly and, bydoing so, has re-arranged the virtual implants. In this particularexample, the dot spacer collided with other virtual implants, movingthem inferiorly, and the implants that the dot spacer pushed downcollided with other implants, which were moved as a result. Thus, theposition of multiple implants can be adjusted in response tointeractions with a single implant that is moved by the user. In oneembodiment, the user may simultaneously touch multiple implants withdifferent fingers and move them independently.

In another embodiment, virtual implants may be locked so that they donot move when other virtual implants collide with them. When virtualimplants are added to a plan, they may be locked in place or mobile,depending on a default setting or user preference.

Locked (immobile) vs. unlocked (mobile) may have differing visualappearances. For example, locked virtual implants may have a lock iconsuperimposed on them or another visual indicator. In another embodiment,locked vs. unlocked implants may have some other visual difference, forexample different colors or different degrees of transparency.

Composite Virtual Implants

FIG. 5F illustrates another example button bar that includes a compositetile button, a “2×2” button in this example. In some embodiments,“composite tiles” may be selected from available carriers and/orcomposites tiles may be created by the user. In general, a compositetile (or “composite carrier” or “composite virtual implant” moregenerally) is a group of tiles (or other virtual implants) that may bemoved concurrently. With reference to the example of FIG. 5F, with the“2×2” button selected, a new composite tile 520 is created in thetreatment plan. In other embodiments, any other combination of virtualimplants may be selected for inclusion in a composite virtual implant.For example, a composite virtual carrier may be created in anyarrangement (e.g., 2×2, 2×3, etc.), and include virtual carriers of anyshape (e.g., squares, rectangles, hexagons, circles, etc.) and havingany characteristics (e.g., all the same seed strength, a pre-set seedstrength for central tiles with a lower seed strength for perimetertiles, etc.).

In some embodiments, the composite virtual implant button (or other userinterface control) comprises a drop-down user interface that allows theuser to select dimensions of the composite virtual implant that isdesired, as well as possibly the specific types of virtual implants tobe included, spacing between virtual implants, characteristics ofcomposite virtual implants (e.g., concurrent movement, separation,etc.), and/or any other characteristics of a composite virtual implant.For example, a default concurrent movement characteristic may indicatethat all virtual carriers of a composite virtual carrier are movedconcurrently when any one virtual carrier is move. A separationcharacteristic may indicate, however, that certain actions performed onone or more virtual carriers of a composite virtual carrier will causethose one or more virtual carriers to be separated from the compositevirtual carrier (and then perform the certain actions). In otherembodiments, these characteristics may have different defaults, may beuser defined, and/or may be selected on-the-fly by a user as compositevirtual implants are created and/or manipulated.

In some embodiments, composite virtual carriers may be created in othermanners. For example, in some embodiments multiple tiles may be selected(e.g., by selecting multiple tiles while holding down the shift buttonon the keyboard) and then a “create composite” button (or similar userinterface element or keyboard shortcut) may be selected (not shown incurrent figures) in order to create a composite virtual carrierincluding each of the selected tiles. In this way, composite tilesincluding various types, quantities, orientations, radiation levels,etc. of virtual implants may be associated as a composite virtualcarrier and manipulated concurrently.

FIG. 5G illustrates placement of a composite tile and movement of thecomposite tile as a single unit. For example, the composite tile in theupper image may be moved to the left by selection of any region of thecomposite. In this way, movement of a group of tiles (or other virtualcarriers) may be easily accomplished without impacting othercharacteristics of the virtual implants.

FIG. 5H illustrates a process of disconnecting a virtual implant from acomposite tile by flipping the virtual implant. As shown at state 530A,the composite tile 520 has been placed on the planning image. At state530B, one of the tiles 521 of the composite tile 520 has been selectedfor flipping (e.g., by selecting the flip button and then selecting tile521). In one embodiment, this operation may result in separation of thecomposite tile into its separate components, such as into the 4 separatetiles, or only separating the one selected/flipped tile and creating anew composite tile including the remaining 3 tiles.

As shown in the example of FIG. 5A, the flipping action applied to tile521 has caused tile 521 to flip (indicated by the larger seedrepresentation in tile 521) and tile 521 to be separated from theremainder of the composite tile, now labeled composite tile 520A toindicate a different composite tile including only three tiles. Withtile 521 separated from the composite tile 520A, it may now beseparately moved, as shown at state 530C, removed from the treatmentplan, as shown at state 530D, and/or otherwise manipulated separate fromthe composite tile 520A.

In other embodiments, a flip (or other) operation may be configured toapply to each virtual implant of a composite virtual implant so that,for example, selection of one virtual implant of a three virtual implantcomposite carrier for flipping would cause all three of the virtualimplant to flip. In some embodiments, the user has both functionalitiesavailable and can select which functionality to use when working with acomposite virtual implant, such as by a user interface control orshortcut key (e.g., holding down on shift while selecting a virtualimplant separates the virtual implant from the composite carrier andcauses only the separated virtual implant to receive the selectedaction, such as flipping, while holding down on Control while selectinga virtual implant causes all virtual implants in the composite toreceiving the selected action).

Example Dose Readings

FIGS. 6A and 6B illustrate a planning user interface 600 depicting anexample planning image in a display frame 610. In this example, the“Read” function of button bar 430 has been selected. As describedherein, the calculated 3D dose that results from the virtual implantsmay be configured to automatically and continuously calculate as theuser manipulates virtual tiles. In addition to a graphical display, forexample in the form of an isodose plan, the user may obtain a numericvalue at any 3D position by tapping a location in display frame 610 tochoose the (x,y) coordinates to report. As discussed elsewhere, thecalculated dosage at a particular selected position may be provided invarious formats (which may be automatically selected by the planningsystem or by the user), such as to provide relative and/or absolute dosereadings. The z position, or depth, may be chosen via the “+|−” buttonsof the user interface or a similar method, with the z position displayedin the upper right corner of the user interface, such as isodose depth452 of FIG. 5C.

In the example of FIG. 6A, an arrow has been displayed in response tothe user tapping a position in the display frame 610 (with the Read modeactivate), which indicates a position to be read. The numeric value ofthe dose at the selected location may then be reported to the right ofthe display frame, starting with “At location:” and may include the 3Dcoordinates of the position chosen as well as the dose, in this example1.721e+04. In other embodiments, different symbols may be displayed toindicate a selected area for providing dose data, or no indicator may bedisplayed in some embodiments. In some embodiments, dose information maybe displayed near or atop the selected treatment surface position, suchas near the arrow illustrated in FIG. 6A.

FIG. 6B illustrates a portion of a planning image at three differentstages 650, 652, and 654 of a treatment planning process. These threestages illustrate examples of readings in different positions. In thisexample, dose decreases with increasing distance from the implants, inthis case the virtual radioactive implants. In particular, at stage 650a dosage calculation for a particular area of treatment plan in a regionof the isodose plan having a visual indicator associated with a highdose range (for example, indicated by a color, e.g., red, and/or patternof between isodose curves, for example) is provided. At the particularselected area at stage 650, the calculated dose is indicated as8.120e+03. At stage 652, in response to the user selecting a positionthat is approximately 7 mm from the more central reading shown at stage650, the isodose plan has a different visual indicator (for example, adifferent color, e.g., intermediate shade of blue, and/or pattern)indicating a lower dose value, and the calculated dose for thatparticular location (in this example) is 3.179e+03. Next, at stage 654,at a position that is even further from the more central reading shownat stage 650, the isodose plan has another visual indicator (forexample, a different color, e.g., dark blue, and/or pattern) to indicatean even lower dose value, indicated in this example as 1.633e+03.

In some embodiments, the implant planning system allows selection of avirtual shielding material for placement on the planning image andinclusion in a developed treatment plan. In such an embodiment, thevirtual shielding material emulates properties of a physical shieldingmaterial such that radiation dosages illustrated in isodose plans areaffected by placement and movement of the virtual shielding material. Inthis way, a user may place a particular virtual shielding material(e.g., multiple sizes, materials, shapes, and/or configurations ofshielding material may be available) beside and/or above one or morecarriers in a treatment plan and the isodose depth may be adjusted sothat radiation levels above the carrier configuration are indicated. Forexample, an isodose depth of +2 cm may cause the planning software togenerate an isodose plan illustrating any (stray) radiation above thepatient's anatomy, such as above bandaging that is placed over aphysical carrier configuration and that may introduce an increasedradiation risk to the patient and or persons that come near the patient.Thus, isodose curve calculation at these levels, and based onconfigurable use of different types and placements of shieldingmaterials, may contribute to a treatment plan having an optimizedefficacy.

Implant Placement Guide System

As discussed below, an implant placement guide system may be used toguide a surgeon in placing physical implants based on a treatment plan,such as an implant plan developed using the implant planning softwarediscussed above. Once a user creates a treatment plan using virtualimplants (such as using the implant planning system discuss above and/orsome other system), there is a need for a system that is efficient,accurate and intuitive to guide the surgeon in placing physical implantsaccording to the plan.

In one embodiment, a treatment plan is projected on to the patientanatomy (e.g. that physical treatment surface of the patient), forexample using a computer display in the form of a projector that canproject visual information on the body, such as a surgical cavity (e.g.,the surface of the brain). The information projected on the treatmentsurface (e.g., the brain surface) can show the surgeon the type,configuration, and/or location of each physical implant that needs to beplaced in or on the treatment surface. FIG. 8 illustrates, for example,an embodiment where a digital projector 160 projects the treatment plan,in this example as the black and white virtual implants, on to thepatient's body 820 (e.g., a treatment surface of the patient that isexposed in a surgical setting and is prepared for receiving physicalimplants). In this example, the treatment plan is projected onto apatient's brain during surgery.

In another embodiment, a live image of the anatomy (e.g., the treatmentsurface of the patient), such as a surgical cavity, is acquired using animaging device, such as a digital video camera, and the treatment plan,including one or more virtual implants, and a live image of the anatomyare simultaneously displayed, for example by graphically superimposingthe virtual implants on the live image, so that the surgeon cansimultaneously and in real-time visualize the plan, surgical bed, hisinstruments, and the physical implants he is placing. In the example ofFIG. 9, a treatment plan including multiple virtual implants and thepatient's anatomy (e.g., from a live video feed from a camera in thesurgical room) are displayed simultaneously, such as on a display devicepositioned in a surgical room, to guide the surgeon in placing physicalimplants at the time of surgery.

In some embodiments, a treatment plan may be implemented in othermanners, such as by 3D printing of physical implants (corresponding tovirtual implants in the treatment plan) either local to the treatmentplanning system (e.g., at the hospital where the treatment plan isdeveloped and the implant placement will occur) or remotely (e.g., at aremote implant provider site that generates the physical implants andmails the implants to the treatment facility). In such an embodiment, 3Dprinted physical implants may include slots for inserting radioactiveseeds, such as just prior to implantation of the physical implants. Inother embodiments, a special-purpose 3D printer may automatically embedradioactive seeds into the printed 3D physical implants, such as byselecting the radioactive seeds from a storage container or magazine andplacing on a partially printed physical implant prior to enclosing theseed in the implant by completing the 3D printing. In some embodiments,the physical implants (whether 3D printed or otherwise manufactured) mayinclude connectors, such as slots and extension members, on opposingphysical implants that allow generation of a physical implant compositethat includes multiple physical implants that are concurrently movable.For example, connectors between each adjacent pair of physical implantsmay be unique, such that physical implants are connectable only in thepattern shown in the developed treatment plan (including ensuringorientation of certain physical implants that may be flipped withrelation to others).

In some embodiments, the implant placement system may include opticalsensors (e.g. one or more cameras) that acquire images of the treatmentarea (e.g., an exposed cavity of human tissue) and automaticallyregisters the acquired images with the planning image on which thetreatment plan was generated. With the current patient positionregistered with the planning image, a robotic placement system mayautomatically place the physical implants on the treatment surface atthe specific positions indicated in the treatment plan. In someembodiments, physical implants may be provided to the robotic system(e.g., such as by the virtual implant provider) in a container whereinthe physical implants are in a particular, known, order, such that therobotic system can pick up a first virtual implant (e.g. a top virtualimplant in a spring-loaded magazine) and place that physical implant atthe location indicated in the treatment plan, and then return to pick upa second physical implant (e.g., that is now at a top of the magazine)and place it at the location determined in the treatment plan, and soon. In other embodiments, the virtual implants may be packaged in othermanners that allow robotic and/or manual placement to be moreeffectively performed.

Registration of Treatment Plan with Physical Anatomy

In order for the treatment plan, including the virtual implants, to beaccurately projected or superimposed on the anatomy, the planning image(and plan which is in the same frame of reference) should be registeredwith the anatomy. For example, the treatment plan and the associatedplanning image (and/or an image derived from the planning image) may betranslated, magnified, rotated, or morphed so that the patient's anatomyand plan match. In this way, the positions, sizes, and orientations ofthe virtual implants can be accurately represented on the patient's bodyto guide accurate placement of physical implants. In some embodiments,the planning image is first registered with a live image of thepatient's anatomy (e.g., an image of the treatment surface of thepatient), and then the planning image (e.g., the combination of implantsthat comprise the developed treatment plan) may be adjusted in the samemanner as the planning image before the treatment plan is implemented.For example, a determined rotation, translation, magnification, etc.calculated in order to register the planning image with a live image ofthe patient's anatomy may be applied to the treatment plan before thetreatment plan is used in the implant placement process.

A number of different methods could be used to register the planningimage with anatomy at the time of implantation. In an embodiment wherethe treatment plan is physically projected on the treatment surface ofthe patient, the location, magnification, and/or rotation of theprojected image may be varied by physically varying the projectionsystem, for example by moving it, or by graphically manipulating theelectronic image being projected.

In the case where the treatment plan is electronically superimposed on alive image of the treatment surface, the planning image and associatedtreatment plan and/or the live anatomic image may be manipulated so thetwo match, for example by adjusting translation, rotation, and/ormagnification of one or both.

In some embodiments, during the process of aligning the planning imageused for the plan and the anatomy at the time of implantation, it may beuseful to vary the appearance of one or both images so that it is easierto determine if they are aligned. In the example of FIG. 7A, theplanning image 710 is manipulated so that it is a roughly black andwhite image 712, for example by removing color and increasing contrast,and then made semitransparent. In this way when it is graphicallysuperimposed on the anatomic image, it may be easier to see if the twoimages superimpose. For example, image 720 of FIG. 7B illustrates theprocessed planning image 712 superimposed on the anatomy and one canappreciate that the images are not perfectly aligned, as evidenced bythe apparent copy of the vessel indicated by the white arrow, and otherduplicated anatomical features. In image 722, however, the two imagesare aligned through rotation and translation so that the anatomicalfeatures in each image, such as the vessel indicated by the white arrow,are precisely aligned.

In various embodiments, different graphical methods may be employed toalign the planning image (coordinate system of the treatment plan) withthe body (anatomy). For example, one image may be subtracted from theother in real time so that user can manually vary translation, rotation,and/or magnification to visually align the two. In other embodiments,the alignment may be performed automatically, for example usingcross-correlation, as implemented by Fram (Crepeau, R. H. and E. K.Fram. Reconstruction Of Imperfectly Ordered Zinc-Induced Tubulin SheetsUsing Cross-Correlation And Real Space Averaging. Ultramicroscopy 6(1981) 7-18), which is hereby incorporated by reference in its entiretyand for all purposes.

In one embodiment, the anatomic image 710 illustrated in FIGS. 7A & 7Bmay represent a live image of the patient's anatomy, for exampleobtained with camera 310 of FIG. 3, 2D or 3D Imager 128 of FIG. 1, orCamera 158 of FIG. 1.

FIG. 10 illustrates a planning system user interface 1000 as may be usedas part of an implant placement process. In this example, in response toselection of the “Video” button by the user, the user interface 1000includes a video window 1010 depicting a live video image (which hasreplaced the previously displayed planning image) and a graphicalsuperimposition of the developed treatment plan. As shown in thisexample, the superimposed treatment plan indicates the type, location,and configuration of each of the virtual implants, which allows thesurgeon to accurately, efficiently, and intuitively position physicalimplants corresponding to the indicated virtual implants in the preciselocations of the virtual implants by simultaneously visualizing thevirtual implants and the treatment surface. Because video window 1010includes a live video feed in this example, surgical instruments,physical implants, and any other physical objects imaged by the cameraare also displayed and may be useful in help the surgeon plan implantswhile looking solely at the video window.

FIG. 11 illustrates another example of imagery that may be displayed inan image/video window, such as window 610 of FIG. 6A of the implantplanning (and placement) software. In this embodiment, the “live image”described with reference to FIG. 10 may be a live image or a staticimage that represents the anatomy at the time of implantation, forexample obtained using intraoperative MRI. The real time position of thesurgical instrument and/or physical implant being placed may be shown asvirtual objects, where the position of the surgical instrument and/orimplant is determined using real time position sensing, for exampleassociated with a surgical robot, a real-time stereotactic surgicallocalizing system, or other real-time position sensing system.

This is illustrated in FIG. 11 where the surgical instrument is shownusing a gray computer graphic 1120, for example representing aninstrument controlled by a surgical robot or a human surgeon, and theposition of the physical implant is shown as a square, textured computergraphic at the end of the instrument.

In the examples illustrated, all the implants in the plan aresimultaneously displayed. In other embodiments, implants may bedisplayed one at a time or in groups, such as groups of adjacentimplants (for example, the treatment plan of FIG. 11 might include threegroups of adjacent implants). After a surgeon places a physical implantin the position of the displayed virtual implant, the virtual implantmay be graphically removed or its appearance otherwise altered and thenext virtual implant can be displayed. In some embodiments, an order ofappearance of the virtual implants may be prioritized, such as based ondefault and/or user preferences. For example, in one embodiment thesystem orders the virtual implants based on an implantation algorithmthat determines a most precise, fastest and/or otherwise optimal orderin which to place physical implants. In one embodiment, the ordergenerally begins on one side of the treatment surface (e.g., a far sidefrom the surgeon) and moves towards the other side of the treatmentservice (e.g., a near side to the surgeon). The process can be repeateduntil all implants are placed.

In one embodiment, the surgeon or a colleague working with the surgeonmay indicate that a physical implant has been placed in the position ofthe currently displayed virtual implant and that the next virtualimplant in the plan should be displayed using input such as voicecontrol, mouse, keyboard, touchscreen, or gesture recognition, forexample using a video camera or Leap motion controller.

In another embodiment, all virtual implants may be displayed but as theuser places a physical implant in the location of a virtual implant, thevisual appearance of the virtual implant may change. In one embodiment,the user may indicate that a physical implant has been placed in thelocation of a specific virtual implant, for example using input systemsas above.

In another embodiment, implants may have unique indicators, such asnumbers superimposed on them, such that the user may indicate that avirtual implant has been replaced by physical implant using voice inputwhich identifies a virtual implant.

In another embodiment, automatic imaging pattern recognition of a videoimage of the surgical bed may be used to detect that a physical implanthas been placed in the location of the virtual implant, and may indicateplacement of the physical implant and/or move on to display a nextimplant for implantation in any of the manners discussed above.

Additional Optional Features

FIG. 12 illustrates a GUI 1200 which is similar to GUI 400 in FIG. 4A,but with additional features. Image frame 1205 displays an image. GUIcontrol 1210 allows adjustment of the plane in which the radiation doseis calculated, with the currently selected plane displayed above thecontrol, e.g., the plane is set at −0.50 cm in the example of FIG. 12.

GUI control 1220 may be used to change the image in display frame 1205,for example to another image of anatomy that is in the same frame ofreference. A label above control 1220 displays a description of thecurrently displayed image. For example, FIGS. 13A and 13B illustratesuse of a stepper button 1220 (or another other interface element) thathas been selected by the user to move between various views of thepatient's anatomy that have been registered, e.g., an intraoperativephotograph displayed in GUI 1310 of FIG. 13A and the 3D rendering from apreoperative MRI in GUI 1320 of FIG. 13B.

GUI control 1230 includes similar buttons and functionality as isdescribed above with reference to button bar 440 of FIG. 5B.

GUI control 1240 includes buttons that control display and erasure ofregions to treat or lesions that may be drawn by the user, as describedfurther below.

Buttons labeled “eMail” and “Clear” have the same or similarfunctionality as described with reference to buttons 456 and 458 of FIG.5C, respectively.

GUI control 1250 includes text indicating a range of radiation dose andsliders to control the upper and lower values, as discussed below withreference to FIG. 19, for example.

GUI control 1260 allows the user to control the range of values used togenerate isodose curves, with the range extending from 0 (or some otherlower boundary) to an upper value controlled by the user with thiscontrol and displayed in text 1262. For example, FIG. 14 illustrates anexample in which the range of values used in calculating isodose curves(and corresponding colors or patterns that are illustrated in thenon-color drawing in FIG. 14 for purposes of clearer publication) arevaried. Such adjustments in the isodose range may be implemented usingthe interface element 1260 (e.g., a stepper) of GUI 1200, for example,to incrementally increase the upper range of values. In this example,the dosage range in image 1410 is illustrated by an isodose plan havinga maximum dose of 10,000 cGy, while in image 1420 the maximum is 9000cGy, in image 1430 it is 8000 cGy, and in image 1440 it is 7000 cGy.Thus, the stepper in this embodiment is configured to decrement (orincrement in response to selection of the plus stepper control) thedosage range in increments of 1000 cGy. In some embodiments, theincrements applied to the dosage range may be automatically determinedfrom the radiation dose in the current plan, such as to providepredetermined (e.g., 10) levels for isodose curves between a minimum(e.g., 0) and a maximum (e.g., 10,000 cGy) radiation level in a isodosegraph.

Button bar 1270 is similar to button bar 420 of FIG. 4B but has anadditional “Image” button that allows the user to display the image andlesions and/or regions to be treated drawn in by the user, as well bedescribed below, without superimposition of the tiles or isodose planwhile maintaining the treatment plan (e.g., a combination of implants)that has been developed.

Button bar 1280 is similar to button bar 430 of FIG. 4C but has anadditional “Draw” button that, when selected, allows the user to drawlesions or regions to be treated on the image in image frame 1205, aswill be described below.

In the example of FIG. 15, a group of virtual carriers has been placedand the resulting radiation dose is plotted in an isodose plan includingmultiple isodose curves and visual indications (e.g., fill patterns orcolors) between adjacent isodose curves.

FIG. 15 illustrates the treatment plan at three tissue depths 1510,1520, and 1530, each having a same isodose curve levels, but atdifferent planes relative to the treatment surface (e.g., brainsurface). Specifically, at stage 1510, the radiation distribution at 0.5cm below the brain surface is shown. As the isodose level changes, suchas by the user selecting the GUI control 1210, the isodose curves areupdated. In this example, at stage 1520 the isodose level has beenadjusted to 0.3 cm below the brain surface and at stage 1530 to 0.1 cmbelow the brain surface. In this example, seeds in carriers (or otherimplants) with small icon bars within them are 0.3 cm above the brainsurface and the “flipped” tiles (large icon bars) have seeds that are0.1 cm above the brain surface, and therefore provide a larger dose asthey are closer to the brain. Note that the radiation dose increases attissue depths closer to the brain surface because tissue at those depthsis closer to radioactive seeds placed above the brain surface.

Example Lesion Simulation

FIG. 16 illustrates a function where the user may draw a region in theuser interface, such as on a planning imaging in the planning systemuser interface, for example using a mouse or a finger on a touch screen.In this embodiment, this functionality to draw a lesion and/or region tobe treated is initiated by the user selecting the “Draw” button of thebutton bar 1280 which allows the user to draw one or more lesions, e.g.,regions to be treated or lesions, onto the patient's anatomy in theplanning image. In the example, the user has drawn a treatment region1602 to be treated in the central portion of the planning image, whichmay be illustrated in various colors or patterns to indicate user drawnportions of the planning image. For example, in one embodiment thetreatment region 1602 is shown in bright yellow color. In thisembodiment, a treatment simulation indicator 1630 indicates a quantityof the added treatment region 102 that is receiving a dose above theminimum dose set by the user. For example, in this embodiment theindicator 1630 shows that 0% of the treatment region 1602 would receivea suitable dose of treatment according to the current treatment plan(which doesn't yet include any implants in the example of FIG. 16).

Moving to FIG. 17A, the same planning image and treatment region 1602from FIG. 16 are shown, but now with an additional treatment region 1702added in the GUI 1710 of FIG. 17A. Thus, as shown in this figure, theuser may draw more than one treatment region. The “Show”, “Hide”, and“Clear” buttons shown on button bar 1240 may be used to control displayof the drawn regions and initiate erasure of the drawn regions. Forexample, the “Show” button cases the drawn region(s) to be displayed(e.g., as in FIG. 17A), the “Hide” button causes them to be hidden(e.g., as in FIG. 17B), and the “Clear” button causes them to be erased(e.g., such that they will not be re-displayed when the “Show” button issubsequently selected).

FIG. 18 illustrates the placement planning user interface at four stages1810, 1820, 1830, 1840 during a portion of a lesion simulation process.As discussed herein, multiple images of the patient's anatomy may beavailable that are in the same frame of reference. In the example ofFIG. 18, two images are available, a 3D volume rendering from apreoperative MRI shown in the planning user interface at stage 1810 andan intraoperative photograph or live video image shown in the planninguser interface at stage 1820. In this example, with the preoperative MRIimage displayed at stage 1810, a first treatment region 1812 has beendrawn by the user (which may be displayed in a particular color ortexture depending on system and/or user preferences) on the preoperativeMRI. In response to the user selecting the control 1220, such as bypressing the “+” button to move through available images in a firstdirection and the “−” button to move through the available images in areverse direction, the 3D volume rendering image at stage 1810 isreplaced with the intraoperative image at stage 1820, but with thetreatment region 1812 remaining on the planning image at stage 1820.Thus, use of multiple planning images in this manner, especially if theimages are registered accurately, may enhance the user's ability toplace example treatment regions and test various treatment plans onthose treatment regions, and may increase efficacy of the developedtreatment plan.

In some embodiments, the draw function allows the user to draw regionson any of the images (e.g., either of the registered images shown atstages 1810 or 1820). For further example, moving to stage 1830, theuser has drawn a second treatment region 1832 on the intraoperativeregion, which may represent a lesion observed at surgery that isespecially visible on the intraoperative image. Next, at stage 1840, theuser has switched back to the original 3D MRI image (e.g., using thecontrol 1220) and both regions 1812 and 1832 remain drawn by the 3Dvolume rendering image.

FIG. 19 illustrates a portion of the planning software user interface atthree stages, 1912, 1922, and 1932. In this example, a treatment plan isadjusted through the stages and dosage on the treatment region 1902 areillustrated. As shown in this example, once a lesion or other treatmentregion is drawn by the user, it may be useful for the user to be shownwhich portions of the drawn region are adequately treated based on acurrent treatment plan, and corresponding dosage, that is indicated bythe user, such as with reference to a prescribed dose range. In theexample of FIG. 19, the treatment region 1910 includes a large number ofsmall subregions and the radiation dose at any desired tissue level isautomatically calculated for each subregion. In the example shown, thepattern (or color in other embodiments) of each subregion isautomatically chosen based on a relationship between the radiation doseto that region and the prescribed dose range. In the example shown,subregions receiving a radiation dose below the prescribed range of5180-6510 cGy at 5 mm below the brain surface are shown in a lighterpattern 1914 (e.g., yellow in a color embodiment), those within theprescribed range in a more dense pattern 1916 (e.g., green in a colorembodiment), and those above the prescribed range in an even more densepattern 1936 (e.g., red in a color embodiment).

In the example of FIG. 19, at stage 1912 the treatment region 1910 isshown with superimposed virtual implants (comprising radiation seeds inthis embodiment). Based on the radiation dose delivered by the seeds,some subregions of the drawn region are displayed in green (subregion1916), indicating that they fall within the prescribed dose range whileother regions are displayed in yellow (subregion 1914), indicating thatthey fall below the prescribed dose range. In addition, the totalfraction of the drawn region that falls within or above the dose rangeis automatically calculated and reported to the user, e.g. “Treated:45%” as shown as treatment coverage information 1918.

Moving to stage 1922, an additional implant 1923 has been added to theplan and now the system is automatically showing the entire treatmentregion 1910 as green and reporting that 100% of the region is treated.

Next, at stage 1932, a centrally located implant 1920 has been flipped,placing the seed within it closer to the tissue, as indicated by thelarger bar icon within the implant 1920. The radiation dose has beenautomatically recalculated and the subregions re-rendered to showcentral subregions 1934 in red, indicating that the dose falls above theprescribed range, and the outer subregions 1936 as green, indicatingthat the dose falls within the prescribed range. The associated %treated remains 100% at stage 1920, as shown in the treatment coverageinformation 1938, as all of the subregions fall within or above theprescribed range. In another embodiment, the % of the total region thatis above the treatment range may be reported also, or alternatively.

FIG. 20 illustrates a portion of a planner user interface at four stages2010, 2020, 2030 and 2040. These example user interfaces illustrate anembodiment wherein the user may interactively change the upper and lowervalues of the prescribed treatment range, for example using graphicaluser interface components such as sliders. In the planner user interfaceillustrated, the lower and upper values of the treatment dose range arereported, e.g., “Dose 5400 to 7000 cGy” and there are associated slidersthat the user may user to adjust these values, e.g., an upper slider mayadjust the upper value and a lower slider may adjust the lower value, orthe opposite. At stage 2010, a treatment region has been drawn by theuser, but no implants (e.g., carriers with seeds) are present. In oneembodiment, subregions (of the treatment region 2012) below thetreatment range are displayed in yellow (illustrated as a sparse dottedpattern in this example), subregions within the treatment range in green(illustrated as a more dense dotted pattern in this example), andsubregions above the treatment range in red (illustrated as an even moredense dotted pattern in this example). In other embodiments, differentcolors schemes, patterns, or visual indicators may be used. At stage2010, because there are no implants present (and, thus, no seeds), thetreatment region is displayed entirely in yellow to indicate allsubregions fall below the treatment range.

Moving to stage 2020, the user has added seven virtual carriers (tilesin this example) over the treatment region, each with a seed. Based onthe plane being evaluated and the treatment range indicated, the entiretreatment region 2012 now falls within the treatment range and istherefore automatically displayed as green.

Next, at stage 2030, the lower value of the treatment range has beenincreased to 5750 (from the lower limit of 5400 illustrated at stage2020) and now the peripheral portions of the treatment region areoutside of the updated treatment rang and, thus, are displayed as yellowsince the dose reaching those subregions falls below the value of 5750cGy, the lower end of the prescribed dose range.

At stage 2040, the lower end of the dose range has been reset to 5400cGy, but the upper end of the dose range has been lowered from 7000 cGyto 5940 cGy. With these changes in the dose range, the peripheralsubregions are displayed in green, indicating that the dose they receivefalls within the treatment range, but the middle portion of the regionis now displayed as red, indicating it is receiving a dose above theprescribed range.

The appearance of subregions at stages 2030 and 2040 is explained by thefact that the central portion of the region is receiving a higher dosethan the peripheral regions based on the arrangement of the seeds andoverlapping radiation from the seeds, which is further discussed withreference to FIG. 21.

FIG. 21 illustrates different display modes for a given treatment regionthat has been drawn on a planning image and a particular treatment plan(including an arrangement of multiple implants). In user interface 2110,the treatment region and implants from stage 2020 of FIG. 20 are shown.In user interface 2120, the isodose plan associated with the treatmentplan includes semitransparent fill patterns (and having varying displaycharacteristics, such as colors, gradients, or fill patterns), and inuser interface 2130 the isodose plan includes solid fill patterns,without (or overlapping) display of the treatment region and carriers.In these examples, higher radiation doses are show as more densepatterns between isodose curves. Thus, the highest dose for thisconfiguration of carriers is in the central portion of the carrierarrangement where radiation from multiple seeds overlaps, and the dosedecreases as distance from the center of the carrier arrangementincreases. Of course, depending on the configuration of the carriers, aswell as the characteristics of the carriers (e.g., seed placement andstrength), the radiation dosage pattern may take on various forms suchas non-uniform arrangements that are shown in other embodiments herein.In some embodiments, buttons or other controls that allow the user toswitch between the display modes illustrated in FIG. 21, or othersimilar display modes, such as of different transparencies, may beprovided in the planning software user interface (or via keyboardshortcuts, voice commands, etc.).

FIG. 22 illustrates a portion of software planning user interface as atreatment region is created, a treatment plan is generated, andindications of dosages to subregions of the treatment region areautomatically displayed and updated as the carrier configurationchanges.

At stage 2210, a treatment region is drawn by the user with noassociated carriers. As in prior examples, the pattern in this treatmentregion (or some color, e.g., yellow, or other visual indicator)indicates that radiation reaching the various subregions of thetreatment region falls below the prescription range. At stage 2220, theuser has added three carriers, each with a seed, to the treatment plan.As shown by the lack of change in the pattern (or color in otherembodiments) of the treatment region, the radiation dose from the threevirtual implants is insufficient to reach the prescribed dose range.

Next, at stage 2230 the three virtual carriers have been flipped(indicate by the larger bar icons), which puts the seeds closer to thebrain (or other treatment surface) and increases the dose to theunderlying brain. Despite that, the radiation dose to the treatmentregion is still insufficient to reach the prescribed dose range and theregion pattern remains unchanged.

At stage 2240, six additional carriers, each having a seed, are added sothat there are now nine seeds, all in a non-flipped configuration. Mostof the treatment region (all but the far right margin of the treatmentregion) has now changed to a more dense pattern (or green color inanother embodiment), indicating that those subregions fall within theprescription range. A small portion of subregions on the right margin ofthe treatment region remain unchanged from the pattern at stages2210-2230, indicating that those subregions still are below theprescription range.

At stage 2250, a tenth carrier, having a seed, has been added on theright and the previously undertreated right margin subregions are nowupdated to indicate they are within the prescribed dose range, causingthe entire treatment region to have a common pattern (or color inanother embodiment).

At stage 2260, which may be an alternative to stage 2250, rather thanadding a tenth seed to the arrangement of seeds shown in 2240, a seed onthe right overlying the undertreated right margin region has beenflipped to increase the underlying dose so that the entire treatmentregion is now within the treatment range and shown with the patternindicating all subregions are within the treatment range (e.g., green ina color embodiment).

Example System Architecture

As noted above, FIG. 1 illustrates an example computing device 150 thatmay perform some or all of the functions discussed herein with referenceto the implant planning system and/or the implant placement guidesystem. In some implementations, these systems may each include one ormore separate computing device with components similar to those incomputing device 150. The computing device 150 may include, for example,a single computing device, a computer server, or a combination of one ormore computing devices and/or computer servers. Depending on theembodiment, the components illustrated in the computing device 150 maybe distributed amongst multiple devices, such as via a local area orother network connection. In other embodiments the computing device 150may include fewer and/or additional components than are illustrated inFIG. 1.

In the embodiment of FIG. 1, the various devices are in communicationvia a network 190, which may include any combination of communicationnetworks, such as one or more of the Internet, LANs, WANs, MANs, etc.,for example.

The computing device 150 includes one or more central processing units(“CPU”) 152, which may each include one or more conventional orproprietary microprocessor(s). The computing device 150 may furtherinclude one or more memories/storage 153, such as random access memory(“RAM”), for temporary storage of information, read only memory (“ROM”)for permanent storage of information, and/or a mass storage device, suchas a hard drive, diskette, or optical media storage device. Thememory/storage 153 may store software code, or instructions, forexecution by the processor 152 in order to cause the computing device toperform certain operations, such as described herein.

The methods described and claimed herein may be performed by anysuitable computing device, such as the computing device 150. The methodsmay be executed on the computing devices in response to execution ofsoftware instructions or other executable code read from a tangiblecomputer readable medium. A computer readable medium is a data storagedevice that can store data that is readable by a computer system.Examples of computer readable mediums include read-only memory,random-access memory, other volatile or non-volatile memory devices,CD-ROMs, magnetic tape, flash drives, and optical data storage devices.

The exemplary computing device 150 may include one or more input devices156 and interfaces, such as a keyboard, trackball, mouse, drawingtablet, joystick, game controller, touchscreen (e.g., capacitive orresistive touchscreen), touchpad, accelerometer, and/or printer, forexample. The computing device may also include one or more displays 155(also referred to herein as a display screen), which may also be one ofthe I/O devices in the case of a touchscreen, for example. Displaydevices may include LCD, OLED, or other thin screen display surfaces, amonitor, television, projector, or any other device that visuallydepicts user interfaces and data to viewers. The computing device 150may also include one or more multimedia devices, such as camera 158,speakers, video cards, graphics accelerators, and microphones, forexample.

In the embodiment of FIG. 1, interfaces 157 provide a communicationinterface to various external devices via the network 190.

In the embodiment of FIG. 1, the computing device 150 also includes oneor more modules 151. In general, the word “module,” as used herein,refers to logic embodied in hardware or firmware, or to a collection ofsoftware instructions, possibly having entry and exit points, written inany programming language, such as, for example, Java, Python, Perl, Lua,C, C++, C#, etc. A software module may be compiled and linked into anexecutable program, installed in a dynamic link library, or may bewritten in an interpreted programming language such as, for example,BASIC, Perl, or Python. It will be appreciated that software modules maybe callable from other modules or from themselves, and/or may be invokedin response to detected events or interrupts. Software modulesconfigured for execution on computing devices may be provided on acomputer readable medium, such as a compact disc, digital video disc,flash drive, or any other tangible medium. Such software code may bestored, partially or fully, on a memory device of the executingcomputing device, such as the computing device 150, for execution by thecomputing device. It will be further appreciated that hardware modulesmay be comprised of connected logic units, such as gates and flip-flops,and/or may be comprised of programmable units, such as programmable gatearrays or processors. The modules described herein are typicallyimplemented as software modules, but may be represented in hardware orfirmware. Generally, the modules described herein refer to logicalmodules that may be combined with other modules or divided intosub-modules despite their physical organization or storage. Modules mayinclude an implant planning system module that performs the functionsdiscussed herein with reference to the implant planning system and animplant placement guide module that performs the functions discussedherein with reference to the implant placement guide system, whether ona single computing device 150 or multiple computing devices 150.

Additional Embodiments

The various features and processes described above may be usedindependently of one another, or may be combined in various ways. Allpossible combinations and sub-combinations are intended to fall withinthe scope of this disclosure. In addition, certain method or processblocks may be omitted in some implementations. The methods and processesdescribed herein are also not limited to any particular sequence, andthe blocks or states relating thereto can be performed in othersequences that are appropriate. For example, described blocks or statesmay be performed in an order other than that specifically disclosed, ormultiple blocks or states may be combined in a single block or state.The example blocks or states may be performed in serial, in parallel, orin some other manner. Blocks or states may be added to or removed fromthe disclosed example embodiments. The example systems and componentsdescribed herein may be configured differently than described. Forexample, elements may be added to, removed from, or rearranged comparedto the disclosed example embodiments.

Conditional language, such as, among others, “can,” “could,” “might,” or“may,” unless specifically stated otherwise, or otherwise understoodwithin the context as used, is generally intended to convey that certainembodiments include, while other embodiments do not include, certainfeatures, elements and/or steps. Thus, such conditional language is notgenerally intended to imply that features, elements and/or steps are inany way required for one or more embodiments or that one or moreembodiments necessarily include logic for deciding, with or without userinput or prompting, whether these features, elements and/or steps areincluded or are to be performed in any particular embodiment.

It should be emphasized that many variations and modifications may bemade to the above-described embodiments, the elements of which are to beunderstood as being among other acceptable examples. All suchmodifications and variations are intended to be included herein withinthe scope of this disclosure. The foregoing description details certainembodiments. It will be appreciated, however, that no matter howdetailed the foregoing appears in text, the systems and methods can bepracticed in many ways. As is also stated above, it should be noted thatthe use of particular terminology when describing certain features oraspects of the systems and methods should not be taken to imply that theterminology is being re-defined herein to be restricted to including anyspecific characteristics of the features or aspects of the systems andmethods with which that terminology is associated.

What is claimed is:
 1. A computing system for developing a treatmentplan for placement of radioactive implants on a treatment surface of apatient, the system comprising: a medical imaging device configured toobtain live medical images of a patient, including a treatment surfaceof the patient that is to receive radioactive therapy; a computerprocessor; and a computer readable storage medium storing programinstructions configured for execution by the computer processor in orderto cause the computing system to: generate a planning user interfaceincluding at least a display frame for viewing anatomical images; and avirtual implant toolbar including at least a first selectable toolconfigured to allow adding of virtual implants to the display frame;display the planning user interface on a display device of the computingsystem; receive, from the medical imaging device, the live medicalimages; display the live medical images in the display frame of theplanning user interface; receive, via user interaction with the firstselectable tool, selection of first virtual implant characteristics fora first virtual implant to be added to a treatment plan for the patient,the first virtual implant characteristics defining first physicalimplant characteristics of a first physical implant adapted forplacement on the treatment surface of the patient, the first physicalimplant characteristics including at least a first implant shape, afirst implant size, and a first radiation characteristic of a firstradioactive seed associated with the first virtual implant, wherein thefirst radioactive seed is embedded within the first physical implant ata position wherein the first radioactive seed does not directly contactthe treatment surface of the patient when the first physical implant isplaced on the treatment surface of the patient; receive, via userinteraction with the first selectable tool, selection of second virtualimplant characteristics for a second virtual implant to be added to atreatment plan for the patient, the second virtual implantcharacteristics defining second physical implant characteristics of asecond physical implant adapted for placement on the treatment surfaceof the patient, the second physical implant characteristics including atleast a second implant shape, a second implant size, and a secondradiation characteristic of a second radioactive seed associated withthe second virtual implant, wherein the second radioactive seed isembedded within the second physical implant at a position wherein thesecond radioactive seed does not directly contact the treatment surfaceof the patient when the second physical implant is placed on thetreatment surface of the patient; display the first virtual implant andthe second virtual implant in the display frame at non-overlappingpositions on the treatment surface of the patient depicted in thedisplay frame, wherein the first and second virtual implants are atleast partially transparent such that a portion of the live medicalimages whereupon the first and second virtual implants are placed isvisible through the at least partially transparent first and secondvirtual implants; receive, via user interaction with the virtual implanttoolbar, selection of a second selectable tool configured to initiatemovement of a selected one or more virtual implants within the displayframe; receive movement inputs associated with the first virtual implantcausing the first virtual implant to contact the second virtual implant;apply a physics algorithm, based on the movement of the first virtualimplant into the second virtual implant, to determine a movement of thesecond virtual implant in response to a virtual force exerted by thefirst virtual implant, maintaining the first virtual implant and thesecond virtual implant at non-overlapping positions on the treatmentsurface; calculate a radiation isodose plan indicative of an expectedradiation dosage from combination of first radiation from the firstphysical implant and second radiation from the second physical implant,wherein the radiation isodose plan includes a plurality of isodosecurves each indicative of a particular radiation level along therespective isodose curve and a plurality of fill patterns betweenadjacent isodose curves, wherein each fill pattern represents aradiation range between adjacent isodose curves; depict the radiationisodose plan in the display frame, wherein the radiation isodose planhas a transparency of less than one hundred percent, such that at leasta portion of the first and second virtual implants and the live medicalimages underneath the radiation isodose plan are visible; and inresponse to a treatment plan generation command from a user of thecomputing system, generate treatment plan data including at least someof the first physical implant characteristics and at least some of thesecond physical implant characteristics.
 2. The computing system ofclaim 1, wherein the program instructions are further configured tocause the computing system to: transmit the treatment plan data to animplant provider with a requested delivery date and location fordelivery of physical implants associated with each of the virtualimplants indicated in the treatment plan.
 3. The computing system ofclaim 2, wherein the treatment plan data is automatically transmittedvia an electronic communication to the implant provider.
 4. Thecomputing system of claim 1, wherein the program instructions arefurther configured to cause the computing system to: receive, from theuser of the computing system, a request to update the live medicalimages to second live medical images of the patient, wherein the livemedical images of the patient and the second live medical images of thepatient depict a common plane of the patient's anatomy.
 5. The computingsystem of claim 4, wherein the program instructions are furtherconfigured to cause the computing system to: execute a registrationprocess to align anatomical features of the second live medical imageswith those of the live medical images such that each particularanatomical feature in the second live medical images will be rendered ata same location in the display frame as the particular anatomicalfeature is rendered in the live medical images displayed in the displayframe.
 6. The computing system of claim 5, wherein the programinstructions are further configured to cause the computing system to:replace the live medical images with the second live medical images inthe display frame, while maintaining display of the first virtualimplant, the second virtual implant, and the radiation isodose plan. 7.The computing system of claim 1, wherein the planning user interfacefurther includes an isodose level user interface control selectable bythe user to adjust a plane parallel to the treatment surface of the livemedical images at which the isodose curves are calculated, whereinadjustment of the plane initiates real-time updating and display of theradiation isodose plan at the updated plane.
 8. The computing system ofclaim 1, wherein the planning user interface further includes an isodosetransparency user interface control selectable by the user to adjusttransparency of the radiation isodose plan.
 9. The computing system ofclaim 8, wherein the isodose transparency user interface controlincludes a first transparency button that, when selected, adjuststransparency of the radiation isodose plan to fifty percent and a secondtransparency button that, when selected, adjusts transparency of theradiation isodose plan to seventy-five percent.
 10. The computing systemof claim 1, wherein the virtual implant toolbar further includes a seedstrength user interface control selectable by the user to adjust seedstrength of a selected virtual implant.
 11. The computing system ofclaim 10, wherein seed strengths that are available for selection in theseed strength user interface control are limited to seed strengths thatare available for use at a determine implantation time.
 12. Thecomputing system of claim 1, wherein the first virtual implantcharacteristics indicate a position of the first radioactive seedbetween a top and bottom surface of the first virtual implant, whereinthe position has a default at a location wherein the first radioactiveseed is closer to the top surface such that more radiation is emittedfrom a top surface of a corresponding physical implant than a bottomsurface of the corresponding physical implant, wherein the virtualimplant toolbar further includes a flip control and, in response to theuser selecting the flip control and selecting the first virtual implant:the position of the first radioactive seed between the top and bottomsurfaces of the first virtual implant is updated so that the position ofthe first radioactive seed is closer to the bottom surface such thatmore radiation is emitted from the bottom surface of the correspondingphysical implant than the top surface of the corresponding physicalimplant; and the radiation isodose plan is updated to reflect anychanges to the calculated expected radiation dosage.
 13. The computingsystem of claim 1, wherein the virtual implant toolbar further includesa composite implant control configured to create an association betweenthe first virtual implant and the second virtual implant, wherein inresponse to the user selecting the composite implant control apositional relation between the first virtual implant and the secondvirtual implant is determined and a composite implant comprising thefirst and second virtual implant in the determined positionalrelationship is defined, wherein the composite implant is moveable bymovement of either of the first or second virtual implant.
 14. Thecomputing system of claim 1, wherein the virtual implant toolbar furtherincludes a composite implant control configured to create a compositeimplant including two or more virtual implants each having commonimplant characteristics, wherein the composite implant is displayed inthe display frame and is moveable in response to movement of any of thetwo or more virtual implants.
 15. The computing system of claim 13,wherein the virtual implant toolbar further includes a flip control and,in response to the user selecting the flip control and selecting thefirst virtual implant of the composite implant, the first virtualimplant is disassociated from the composite implant such that a positionof a first seed in the first virtual implant is updated, but a positionof the second radioactive seed in the second virtual implant is notupdated.
 16. A non-transitory computer readable storage medium storingprogram instructions configured for execution by one or more computerprocessors to cause a computing system to: generate a planning userinterface including at least a display frame for viewing anatomicalimages; and a virtual implant toolbar including at least a firstselectable tool configured to allow adding of virtual implants to thedisplay frame; display the planning user interface on a display deviceof the computing system; receive, from a medical imaging device, a liveimage of a treatment surface of a patient; display the live image in thedisplay frame of the planning user interface; receive, via userinteraction with the first selectable tool, selection of first virtualimplant characteristics for a first virtual implant to be added to atreatment plan for the patient, the first virtual implantcharacteristics defining first physical implant characteristics of afirst physical implant adapted for placement on the treatment surface ofthe patient, the first physical implant characteristics including atleast a first implant shape, a first implant size, and a first radiationcharacteristic of a first radioactive seed associated with the firstvirtual implant, wherein the first radioactive seed is embedded withinthe first physical implant at a position wherein the first radioactiveseed does not directly contact the treatment surface of the patient whenthe first physical implant is placed on the treatment surface of thepatient; receive, via user interaction with the first selectable tool,selection of second virtual implant characteristics for a second virtualimplant to be added to a treatment plan for the patient, the secondvirtual implant characteristics defining second physical implantcharacteristics of a second physical implant adapted for placement onthe treatment surface of the patient, the second physical implantcharacteristics including at least a second implant shape, a secondimplant size, and a second radiation characteristic of a secondradioactive seed associated with the second virtual implant, wherein thesecond radioactive seed is embedded within the second physical implantat a position wherein the second radioactive seed does not directlycontact the treatment surface of the patient when the second physicalimplant is placed on the treatment surface of the patient; display thefirst virtual implant and the second virtual implant in the displayframe at non-overlapping positions on the treatment surface of thepatient depicted in the display frame, wherein the first and secondvirtual implants are at least partially transparent such that a portionof the live image whereupon the first and second virtual implants areplaced is visible through the at least partially transparent first andsecond virtual implants; receive, via user interaction with the virtualimplant toolbar, selection of a second selectable tool configured toinitiate movement of a selected one or more virtual implants within thedisplay frame; receive movement inputs associated with the first virtualimplant causing the first virtual implant to contact the second virtualimplant; apply a physics algorithm, based on the movement of the firstvirtual implant into the second virtual implant, to determine a movementof the second virtual implant in response to a virtual force exerted bythe first virtual implant, maintaining the first virtual implant and thesecond virtual implant at non-overlapping positions on the treatmentsurface; calculate a radiation isodose plan indicative of an expectedradiation dosage from combination of first radiation from the firstphysical implant and second radiation from the second physical implant,wherein the radiation isodose plan includes a plurality of isodosecurves each indicative of a particular radiation level along therespective isodose curve and a plurality of fill patterns betweenadjacent isodose curves, wherein each fill pattern represents aradiation range between adjacent isodose curves; depict the radiationisodose plan in the display frame, wherein the radiation isodose planhas a transparency of less than one hundred percent, such that at leasta portion of the first and second virtual implants and the live imageunderneath the radiation isodose plan are visible; and in response to atreatment plan generation command from a user of the computing system,generate treatment plan data including at least some of the firstphysical implant characteristics and at least some of the secondphysical implant characteristics.
 17. A method performed by a computingsystem having one or more computer processors, the method comprising:generating a planning user interface including at least a display framefor viewing anatomical images; and a virtual implant toolbar includingat least a first selectable tool configured to allow adding of virtualimplants to the display frame; displaying the planning user interface ona display device of the computing system; receiving, from a medicalimaging device, a live image of a treatment surface of a patient;displaying the live image in the display frame of the planning userinterface; receiving, via user interaction with the first selectabletool, selection of first virtual implant characteristics for a firstvirtual implant to be added to a treatment plan for the patient, thefirst virtual implant characteristics defining first physical implantcharacteristics of a first physical implant adapted for placement on thetreatment surface of the patient, the first physical implantcharacteristics including at least a first implant shape, a firstimplant size, and a first radiation characteristic of a firstradioactive seed associated with the first virtual implant, wherein thefirst radioactive seed is embedded within the first physical implant ata position wherein the first radioactive seed does not directly contactthe treatment surface of the patient when the first physical implant isplaced on the treatment surface of the patient; receiving, via userinteraction with the first selectable tool, selection of second virtualimplant characteristics for a second virtual implant to be added to atreatment plan for the patient, the second virtual implantcharacteristics defining second physical implant characteristics of asecond physical implant adapted for placement on the treatment surfaceof the patient, the second physical implant characteristics including atleast a second implant shape, a second implant size, and a secondradiation characteristic of a second radioactive seed associated withthe second virtual implant, wherein the second radioactive seed isembedded within the second physical implant at a position wherein thesecond radioactive seed does not directly contact the treatment surfaceof the patient when the second physical implant is placed on thetreatment surface of the patient; displaying the first virtual implantand the second virtual implant in the display frame at non-overlappingpositions on the treatment surface of the patient depicted in thedisplay frame, wherein the first and second virtual implants are atleast partially transparent such that a portion of the live imagewhereupon the first and second virtual implants are placed is visiblethrough the at least partially transparent first and second virtualimplants; receiving, via user interaction with the virtual implanttoolbar, selection of a second selectable tool configured to initiatemovement of a selected one or more virtual implants within the displayframe; receiving movement inputs associated with the first virtualimplant causing the first virtual implant to contact the second virtualimplant; applying a physics algorithm, based on the movement of thefirst virtual implant into the second virtual implant, to determine amovement of the second virtual implant in response to a virtual forceexerted by the first virtual implant, maintaining the first virtualimplant and the second virtual implant at non-overlapping positions onthe treatment surface; calculating a radiation isodose plan indicativeof an expected radiation dosage from combination of first radiation fromthe first physical implant and second radiation from the second physicalimplant, wherein the radiation isodose plan includes a plurality ofisodose curves each indicative of a particular radiation level along therespective isodose curve and a plurality of fill patterns betweenadjacent isodose curves, wherein each fill pattern represents aradiation range between adjacent isodose curves; depicting the radiationisodose plan in the display frame, wherein the radiation isodose planhas a transparency of less than one hundred percent, such that at leasta portion of the first and second virtual implants and the live imageunderneath the radiation isodose plan are visible; and in response to atreatment plan generation command from a user of the computing system,generating treatment plan data including at least some of the firstphysical implant characteristics and at least some of the secondphysical implant characteristics.